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How Care Coordination Can Help Decrease Utilization

Last week, we shared part one of a three-part series on care coordination. In part two, we’ll look at how care coordination can decrease both inpatient and emergency department (ED) utilization, especially for high-need, high-cost Medicaid patients and patients struggling with behavioral health conditions or substance use disorder (SUD).

Reducing Inpatient Utilization for At-Risk Patients

A study of over 250 high-need, high-cost Medicaid patients found that those given complex care management had fewer inpatient days, inpatient admissions, and specialist visits. The results of this study found that inpatient utilization was reduced by 59 percent, indicating that carefully designed complex care management and targeted interventions can be effective among vulnerable patients with chronic medical conditions and social or behavioral needs.

Decreasing ED Utilization for Behavioral Health Patients

In addition to inpatient utilization, care coordination has been found to decrease ED utilization. Sturdy Memorial Hospital in Massachusetts is a small, independent hospital that was struggling to find beds and funding to care for behavioral health patients. To minimize ED boarding, Sturdy Memorial turned to care collaboration technology to gain insights into these patients and connect them with better resources. Having this real-time information took the guesswork out of the equation for Sturdy Memorial’s care team members.

By contacting the right case managers, coordinating care, and transitioning behavioral health patients to appropriate care settings, Sturdy Memorial achieved a 78 percent decrease in unnecessary ED utilization by behavioral health patients enrolled in Sturdy Memorial’s program.

Addressing the Opioid Epidemic

The Community Hospital of the Monterey Peninsula (CHOMP) found that patients with high utilization patterns accounted for nearly 30 percent of all ED visits. Many of these patients also struggled with behavioral health issues or substance use disorder. 

Dr. Reb Close, an emergency physician at CHOMP explained how the hospital cared for these patients in a Healthcare IT News article: “CHOMP has combined local opioid prescribing guidelines with the state prescription drug monitoring program (PDMP) and care coordination to improve substance use disorder and put a stop to opioid misuse.”

CHOMP turned to care coordination technology—that integrates directly with the state PDMP—to facilitate better collaborations and gain relevant, real-time information on patients. The combination of this collaboration and the Monterey Prescribe Safe Initiative has helped Monterey County reduce ED visits by 59 percent, opioid deaths by 32 percent, and the number of narcotic pills prescribed at local primary care clinics by 50 percent.

Read the final installment in this care coordination series. Part three discusses how care coordination can help care teams cut down on costs.

Brittany Eastman
Content Marketing Specialist