Development and Implementation of a Value-Based Care Telehealth Emergency Medicine Program: Triage and Care Alignment in an Integrated Health System
DOI:
https://doi.org/10.30953/thmt.v9.512Keywords:
emergency medicine, health outcomes, healthcare cost, telehealth, urgent care, value-based careAbstract
Background: Acute unscheduled episodic care is an area of potential cost savings, given the high frequency and cost of unnecessary emergency department (ED) utilization.
Methods: We developed a provider-assisted patient navigation program using a telehealth platform designed to decrease ED utilization and reduce costs while providing exceptional patient satisfaction.
Results: Urgent care (UC) visits were analyzed from July 1, 2022, to June 30, 2023. The “ED comparison” group (n = 68,320) consisted of patients discharged to home after receiving care in the ED. The “avoided ED visits” group included patients (n = 7,430) who received care in a lower-acuity setting and did not require emergency services within 48 hours. The calculated overall medical expense savings comparing the costs between the ED vs. lower-acuity settings revealed that 50% (n = 450) of consultations were managed as outpatients, avoiding ED visits. Evaluation of distribution by source revealed that 67% of ConnectCare consults resulted in admission, 48% for UC, while 36% of patients were service center consults. Conversely, 31% of consultations resulted in recommendations to go to the ED, and 16% of these were assisted transfers where the Telehealth Emergency Medicine (TeleEM) clinician communicated with the receiving ED. Among the 280 patients directed to the ED, 243 were sent because of immediate clinical acuity, 28 were because of logistical or scheduling issues, three for non-qualifying insurance for outpatient workup, and six were redirected to the ED following diagnostic results. Our analysis suggests an estimated average avoided medical expense of $1,701 per case to insurers and patients if an ED visit was avoided.
Conclusion: Implementing a TeleEM program to assist with triage and resource alignment, as well as identification and outpatient management of patients while avoiding an ED visit, is feasible within an integrated health system. Our TeleEM program may be a model for other integrated health systems.
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Copyright (c) 2024 Austin T. Smith, MD, Julie K. Martinez, MSN, Joel R. Taylor, MD, Kelcie A. Douglas, MHA, Joseph R. Bledsoe, MD5
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