Anthem BCBS in Virginia launches initiative to reduce unnecessary ER visits

Anthem Blue Cross and Blue Shield in Virginia recently launched an educational campaign to educate consumers about healthcare options available to them when a primary care physician isn’t available.

The intent of the campaign is to let consumers know the emergency room isn’t the only alternative when seeking treatment. Options include retail health clinics, walk-in doctor's offices and urgent care centers – all of which, officials say, can provide the same care in less time and less out-of-pocket expense than an ER visit.

"Traditionally, emergency room visits are some of the most expensive episodes in the healthcare industry," said C. Burke King, Anthem's president in Virginia. "By utilizing technology to provide general education in innovative ways, we can help our members make better educated healthcare decisions and be better stewards of their healthcare dollar."

Methods being used to reach out to Anthem members in Virginia include a Google map that identifies all the ER alternatives, including urgent care centers, walk-in doctor's offices and retail health clinics. Consumers can also find the information by typing “Anthem urgent care” in search engines or visiting the member section of the Anthem Web site. The company also expects to launch an iPhone app later this year.

Physicians, too, can access this information to help direct members to the best care, based on their condition.

According to statehealthfacts.org, Virginia residents made more than 3 million ER visits in 2008. And while the state’s ER use per capita is slightly lower than the national average, internal research conducted by Anthem indicates that more 60 percent – or 1.8 million – of ER visits were for conditions that could have potentially been treated in urgent care centers at a fraction of the cost.

Average costs ranged from $441 for an ER visit to $98 for urgent care and $52 for retail care. These costs represent total costs, including the portion paid by the health plan member.

According to the American College of Emergency Physicians, while ER visits have steadily increased in the past few years, the higher cost of visiting an ER is not because of overcrowding but due to the fact that roughly half the care provided is uncompensated, as mandated by the Emergency Medical Treatment and Labor Act.

ER spending represents roughly 3 percent of a hospital's total expenditures. According to the ACEM, a bigger concern to the continuing viability of hospital ERs – in addition to uncompensated visits – is that “health plans often look only at the frequency and cost of isolated patient visits and not the value of the emergency medical system as a whole. Emergency physicians continue to be concerned that payer policy jeopardizes the health of their patients.”

Nevertheless, in an environment where insurance companies are feeling the squeeze on their profit margins, finding ways to spend less for the same care is important to large payers such as Anthem.

In addition to using information on the company's Web site, Anthem members with the 24/7 NurseLine benefit can also contact an Anthem registered nurse to learn the best place to seek care for a medical problem.

"By leveraging technology and cataloging all the necessary information, Anthem's nurse hotline can effectively triage members and provide them with all of their choices ultimately for the member to decide the appropriate venue for care," said Manish Oza, MD, Anthem's medical director and a practicing ER physician.

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