Excessive emergency department overutilization is one of the leading causes of increased healthcare costs. Non-emergency visits to the emergency department (ED) reduce access to critical care and resources needed for treatment of critical care. Targeted member/patient outreach and education, like the programs offered by SPH Analytics, have shown to be an effective strategy for reducing avoidable emergency department visits.

It is estimated approximately one-third of emergency department (ED) visits are classified as unnecessary or avoidable, and the majority of the patients seen in emergency rooms across the nation are for non-emergent reasons.

SPH works with you to develop an outreach program and scripting that leads your members to take action, while delivering a custom message specific to your needs.

Our call center engagement specialists become an extension of your organization. SPH’s talented team of onsite professionals are experts at not only reaching your members, but also in delivering targeted education at any level.

Department Overutilization:

  • Educate member on emergency department utilization
  • Locate in-network physicians
  • Assist in appointment scheduling
  • Conduct follow-up reminder calls in 30, 60 or 90 days
  • Educate member about transportation, nurse line, and OTC benefits
  • Provide member with referrals and information on urgent care centers
  • Help resolve Rx questions and issues
  • Mail educational materials to the member (or provide alert in your system)
  • Provide referrals and/or phone transfers to other departments or services (case management, behavioral health)
  • Additional services customized to your objectives

By working to educate members about emergency department alternatives, providing referrals to urgent care facilities, resolving prescription questions, and following up with reminder calls, frequent ED patients are encouraged to seek in-network providers for non-emergency care.

In addition to reducing costs and optimizing emergency department resources, SPH Analytics will continue to work with you to monitor and adjust the program for maximum results.

Contact us for additional information about SPH Analytics’ Emergency Department Overutilization Program.

Partner with a Trusted Leader

SPH Analytics has more than 25 years of experience driving quality program success. We have the experience and expertise clients trust to improve clinical care, enhance patient experience, and reduce costs to meet the Triple Aim.