Emergency Medicine

How Payers Can Reduce Emergency Department Admission Rates, Costs

August 9, 2023 - Members and payers do not always see eye-to-eye, but one point on which they closely align is their desire for members to stay out of the emergency department. Emergency department visits are associated with higher healthcare spending. A single trip to the emergency room costs $2,453, on average, under a large employer-sponsored health plan. The out-of-pocket costs can range from $128...

Read More


More Articles

Common Utilization Measures That Impact Value-Based Care Efforts

by Kelsey Waddill

Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality...

Medicare Advantage Beneficiaries See Lower Hospitalization Rates

by Victoria Bailey

Medicare Advantage beneficiaries with ambulatory care sensitive conditions (ACSCs) experienced lower rates of hospitalizations but higher rates of emergency department (ED) direct discharges and...

Emergency Department Patients Are More Likely to Have Chronic Diseases

by Kelsey Waddill

Chronic diseases are common among emergency department patients, particularly among seniors and those ages 45 to 64, according to a National Health Statistics Report. “Monitoring ED visits made...

How Eliminating Individual Mandate Impacted the Latino Community

by Kelsey Waddill

After Congress zeroed out the Affordable Care ACct's individual mandate, the Latino community experienced a rise in uninsurance that coincided with a deterioration in other important quality of...

UHC Will Not Implement Emergency Care Coverage Changes

by Kelsey Waddill

UnitedHealthcare has clarified that it does not intend to change its emergency care coverage policies, American Hospital Association (AHA) disclosed in a special bulletin. “AHA is pleased with...

UHC Temporarily Reverses Emergency Department Coverage Policy

by Victoria Bailey

UnitedHealthcare (UHC) has announced it will delay its recent protocol change regarding emergency department (ED) claims and coverage, after receiving backlash from providers and health organizations...

UHC Changes Emergency Department Claims Evaluation Protocols

by Victoria Bailey

Editor's Note: UHC has delayed implementation of this policy. Find out more here. UnitedHealthcare (UHC) announced in a network bulletin that it will be changing some of its methods around...

Medicaid Expansion May Boost Homeless Individuals’ Access to Care

by Kelsey Waddill

Medicaid expansion might ensure that homeless individuals receive access not only to healthcare coverage, but also to the care that they need, a Health Affairs study found. “Our results provide...

Individual Insurance Market Premiums Cover Widely-Used Services

by Kelsey Waddill

The individual health insurance market’s premiums mostly go towards highly utilized services, a Robert Wood Johnson study discovered. “The requirement that these essential benefits be...

Humana’s Value-Based Care MA Model Cuts ED Admissions, Costs

by Kelsey Waddill

Humana’s value-based care models in Medicare Advantage helped lower emergency room admissions and, in turn, boosted savings for Medicare Advantage members, according to the payer’s recent...

Surprise Billing Policies May Decrease Commercial Payer Premiums

by Kelsey Waddill

For three major payers, surprise billing policies had an impact on premiums, a study published in the American Journal of Managed Care found. The researchers used data from the Health Care Cost...

Aetna Fined $500,000 for Denying Emergency Room Claims in CA

by Kelsey Waddill

Aetna has been fined by California’s Department of Managed Health Care for denying emergency room claims against the state’s standards. “The plan’s failure to follow California...

Out-of-Network Healthcare Spending Spikes for Lab Tests, Pathology

by Kelsey Waddill

While overall out-of-network or potential surprise billing is slightly declining, out-of-network healthcare spending is on the rise for laboratory tests and hospitalists—particularly in...

VA Medicaid Program Reduces ED Admissions for Opioid Use Disorder

by Samantha McGrail

After the implementation of Virginia’s Medicaid program, Addiction and Recovery Treatment Services (ARTS), emergency department (ED) visit declined by 21.1 percent among beneficiaries with opioid...

BCBSRI Program Aims to Lower Senior Adverse Drug Events by 20%

by Kelsey Waddill

Adverse drug events in older Americans cost approximately $3.8 billion in 2018, but a new program from Blue Cross Blue Shield of Rhode Island (BCBSRI) is looking to reduce costs by 20 percent while...

HHS Launches Emergency Services Payment Model for FFS Medicare

by Jessica Kent

HHS and the CMS Innovation Center have announced a new payment model for emergency and ambulance services that will enable Medicare fee-for-service beneficiaries to receive quality care with lower...

Emergency Physician Group Sues Anthem for ED Payment Policies

by Thomas Beaton

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have filed a lawsuit against Anthem BCBS of Georgia contesting an emergency department payment policy...

BCBS of TX Delays Non-Emergency ED Claims Review Policy

by Thomas Beaton

BlueCross BlueShield of Texas has delayed implementation of a claims review policy that would require HMO members to pay the total cost of an emergency department visit if the encounter is later deemed...

Urgent Care Center Utilization Skyrocketed by 1725% in Last Decade

by Thomas Beaton

Healthcare payers saw urgent care center utilization grow by 1725 percent from 2007 to 2016, indicating that urgent care may the one of the fastest-growing choices for receiving healthcare. A white...

Recent Articles