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Leveraging Real-Time Data to Reduce Unnecessary ED Utilization

An increasingly lesser known fact about me is that I started my career as a Physical Therapist treating orthopedic patients. There is a phenomenon known as the “pain cycle” that we regularly tried to break. In that cycle, an initial trauma causes pain, pain causes muscle spasm, muscle spasm reduces blood flow and reduced blood flow causes more pain. As you can imagine, that becomes perpetual until at least one of the elements is removed—thereby breaking the cycle. 

At a macro level, there are so many cycles we try to break across the industry in pursuit of improved outcomes and lower costs. Leveraging real-time notification technology, our partners at CareOregon have done just that. In this case, they identified their Medicaid population was accessing the emergency department (ED) for dental problems at a disproportionate rate. The ED is set up to treat the symptom, but not the root cause and because the root cause is not resolved the member ends up back in the ED—a self-perpetuating cycle that leads to poor outcomes and drives up costs.

To solve for this, CareOregon leveraged Collective’s analytic platform and real-time data to notify them any time a member was in the ED for dental problems. This enabled them to engage with the member immediately following the ED visit and get them definitive follow up with a dental clinic to solve the root cause. Because of real-time intervention, they experienced higher rates of engagement, more dental follow-up visits, and fewer returns to the ED. Within two years, the percentage of members receiving follow-up care increased 3.5 percent.

In the past, I’ve heard it said (by a health plan CMO) that health plans are not capable of impacting the care of their members. While that may have been true in the past, Collective’s health plan clients are proving that not to be the case. Through the power of collaborative care technology, health plans gain a real-time understanding of how and when their members are accessing care. With that understanding, plans can take action at a time when their members are most in need and most likely to engage.

Further, health plans are leveraging their robust longitudinal records and care management expertise to communicate critical information into the treating providers’ EMR through the Collective platform. Traditionally, this valuable information was rendered nearly useless as there was no vehicle to communicate into the provider’s workflow.

As an example, one of Collective’s health plan clients flags their members who’ve been prescribed three medications that when taken together place them at a very high risk of death from overdose. A treating provider would likely not have this information. However, with Collective, it’s pushed to them as the patient is sitting in front of them, enabling them to address the issue.

We have found our health plan clients to be very innovative at developing use cases that leverage real-time understanding and EMR connections. In doing so, they’re breaking the cycles that drive utilization and adverse outcomes for their highest need members and populations.

Michael Keyes, MBA, PT
VP, Health Plan Business Development