Coalition targets reduction in ER visits

A new business coalition with a goal of reducing the number of avoidable emergency room visits by 20 percent over two years and saving about $100 million will formally launch next week by hearing from the head of a similar effort underway in Missouri.

The Massachusetts Employer Health Coalition -- spearheaded by Associated Industries of Massachusetts and the Massachusetts Taxpayers Foundation with an assist from the state Health Policy Commission (HPC) -- plans to work with doctors, hospitals and health insurers to “shift as many avoidable [emergency department] visits as possible to high-value, lower-cost settings to relieve crowded EDs, reduce the cost of care, and improve quality.”

The group, whose members are facing rising costs and stalled health care cost containment talks on Beacon Hill, is planning a Dec. 11 kickoff breakfast. Louise Probst, the executive director of the St. Louis Area Business Health Coalition, an employer coalition supporting more than 60 self-insured employers, and the head of a regional health improvement collaborative, will give a keynote address.

“The good news is that employer coalitions in other areas of the country have already succeeded in curbing unnecessary use of emergency departments,” coalition organizers wrote in an announcement of the UMass Club breakfast.

The HPC reported last year that 42 percent of all emergency department visits in Massachusetts in 2015 were avoidable and that the use of emergency departments (EDs) for non-urgent medical conditions is “a state-wide concern.” The HPC said the most common conditions for which people had avoidable emergency visits in 2015 were sinus infections, stomach pain, rashes or skin conditions, acid reflux, bronchitis, dental pain, back pain, allergies, urinary tract infections, and eye or ear infections.

“The rising cost of providing health insurance to employees remains the most pressing issue facing the 4,000 employers who are members of Associated Industries of Massachusetts,” AIM President and CEO Richard Lord said.

A 2016 study by the HPC found that Massachusetts had the 13th highest rate of emergency room utilization in the US and that 13.7 percent of emergency visits could be diverted to retail clinics while another 13.4 percent could be diverted to urgent care facilities.

In a report released in early May, the HPC included reducing avoidable emergency department visits as one of seven strategies for reducing overall health care costs in Massachusetts. The HPC estimated that its recommendations, which went beyond what the coalition is pitching, could result in $351.7 million in net savings over five years.

At the Dec. 11 kickoff breakfast, the coalition plans to “unveil resources that employers will use to engage with their workers about the importance of seeking medical care in appropriate settings,” including educational materials and steps to help employers and employees identify local care options.

The coalition said it plans to employ four tactics toward its goal.

First, the coalition hopes to educate employees about what issues are best handled by an emergency room and which can be addressed at a clinic or urgent care center. The group will track and report the rate of avoidable emergency visits and will advocate for policy changes like the expansion of accountable care organizations, telemedicine and more. And the coalition hopes to work across the health care sector to “reward and encourage the appropriate use of the ED by aligning financial incentives, and bolster the availability of care in the community, especially during nights and weekends.”