PHARMACY

WellPoint’s new program helps patients choose ER alternatives for nonemergency issues

BY Antoinette Alexander

INDIANAPOLIS — Locating retail health clinics and urgent care centers just got easier for patients seeking nonemergency care when their regular doctors are not available, thanks to an emergency room program and education campaign that incorporates Google Maps launched by WellPoint’s affiliated health plans.

"When your five-year-old is crying with a fever at 7 p.m. on a Friday because she has a sore throat or an ear ache, what do you do?" stated Manish Oza, a WellPoint medical director who helped shape the program and also practices as an ER physician. "It’s important people know that they have options to treat less serious ailments other than an ER, such as retail health clinics and urgent care centers that provide quality care and cost them significantly less."

Enter the new ER program, which includes:

  • Ads on Google, Yahoo! and Bing that drive visitors to an educational site explaining when it’s appropriate to use ER alternatives, such as retail health clinics and urgent care centers;

  • A Google map, available to everyone, that provides the location of ER alternatives in the state so that consumers can easily find them;

  • Automated calls to educate members whose recent ER visits were potentially avoidable, and emails to members interested in learning more information; and

  • Educational pieces mailed explaining the type of conditions that could be treated at ER alternatives and potential differences in cost.

According to a RAND Corp. study published in the September 2010 edition of Health Affairs, about 17% of all visits to hospital emergency departments nationally potentially could be treated at retail medical clinics or urgent care centers for an estimated savings of $4.4 billion. ER visits also are getting longer, with the national average clocking in at four hours and five minutes, according to the 2008 Emergency Department Pulse Report by Press Ganey Associates.

Research conducted by HealthCore, WellPoint’s outcomes research subsidiary, showed that a pilot program with a commercially insured population in Virginia, which included member education via emails and online advertising, in addition to financial incentives and a Google map finder for retail health clinics and urgent care centers, assisted in members’ decisions to use ER alternatives for nonemergency care.

The study showed that ER use for conditions that could be treated at retail health or urgent care clinics decreased in 2010 from 2009 for all populations studied. Specifically, HealthCore reported a 14% decrease in ER visits for those who participated in the program compared with those who did not. The decrease in visits covered minor sicknesses or conditions that could be treated elsewhere.

In addition to the education campaign, members in the study had financial incentives to help them save out-of-pocket expenses. For example, emergency room charges may average $580 to treat strep throat, depending on location, compared with $90 at urgent care centers and $40 at retail health clinics; ER co-pays range from $100 to $200, compared with $10 to $40 for retail health clinics and urgent care centers.

After the program concluded, the group exposed to the program was more than twice as likely to seek treatment for nonemergency conditions at retail health clinics than those who did not participate.

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Report: Anxiety disorders capture one-third of mental health spending

BY Alaric DeArment

LONDON — One-third of spending on mental health in the United States, or $42 million, goes toward anxiety disorders, according to a new report by Companies & Markets.

The report found that the global anxiety disorders market would likely rise in value to $5.9 billion by 2017, thanks to increasing stress levels exacerbated by an unstable economic climate, the aging of the population, an increase in patients with anxiety disorders and new drug development.

In Europe, more than one-quarter of the population is believed to have some sort of brain-related disorder, particularly depression, while 5% growth per year is expected in the Asia-Pacific region.

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Medicare and Medicaid FAST Act takes aim at cutting waste, fraud and abuse

BY Allison Cerra

ALEXANDRIA, Va. — Bipartisan legislation that is aimed to eliminate waste, fraud and abuse in Medicare and Medicaid programs has been introduced to Congress.

Sens. Tom Carper, D-Del., and Tom Coburn, R-Okla., said that the Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers’ Dollars Act, which was unveiled Wednesday, would address the aforementioned problems, which often lead to tens of billions of dollars lost to waste and fraud in Medicare and Medicaid every year, the senators said.

The legislation, also referred to as the FAST Act, is cosponsored by Sens. Michael Bennet, D-Colo.; Mike Enzi, R-Wyo.; Bob Corker, R-Tenn.; Scott Brown, R-Mass.; Amy Klobuchar, D-Minn.; and John Thune, R-S.D.

Responding to the introduced legislation, the National Community Pharmacists Association said that although the group was continuing to review the legislation, it applauded the senators’ efforts, stating that "every dollar that is lost to fraudsters or misspent on bloated administrative expenses increases costs for everyone, jeopardizes patients’ access to pharmacists and other providers and creates artificial pressure on provider reimbursements, which already don’t necessarily cover the cost of providing care."

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