Ending the horrible loop of super utilization: A breakthrough approach to care management

Emergency departments provide an essential role in the health care ecosystem, but a significant proportion of visits to the emergency department are for care that might have been delivered in a doctor’s office.  Reducing the rate of potentially preventable emergency room visits is a key indicator for effective population health management and is often a key metric established by Medicaid agencies and in value-based purchasing contracts between health plans and health care delivery systems.

Talk to doctors, nurses, or social workers in any emergency department and you will hear stories about people who seem to be caught in a horrible loop that brings them back again and again. Sometimes this is the result of a particular disease process, but more often it is the outcome of an unfortunate confluence of circumstances.

After graduating as Chief Resident in Emergency Medicine at LA County/USC hospital in 2002, Dr. Jason Greenspan practiced with Emergency Medical Associates across Los Angeles’s San Fernando Valley.  He is currently the Associate Chief Medical Officer and Regional Director of the San Fernando Valley for EMA and has seen this horrible loop all too often.

In a conversation recorded for 3M’s Inside Angle Podcast, Dr. Greenspan describes how technology help his organization overcome barriers across non-interoperable electronic medical record systems to shine a light on people caught in this loop across multiple different emergency rooms in a region. “A surprise is the people who are going to multiple different ERs.  This is a whole new type of frequent flier. What you thought was 20 visits was actually 40 visits.”

Patterns emerged from the data that enabled his group to recognize the root cause as a combination of issues requiring holistic management. These patterns pointed to homelessness, need for medication management, access to mental health and physical health care and more.

This program is engaging with local police, mental health agencies and others to better meet the needs of these people. For instance, checking in with a homeless person frequently to help them maintain a beneficial course of treatment.

Come listen to Dr. Greenspan’s description of work that he reports is giving emergency department staff the sense that they can and are making a positive difference.

L. Gordon Moore, MD, is senior medical director, Clinical Strategy and Value-based Care for 3M Health Information Systems.