HEALTH INSURANCE: ED Overcrowding – Addressing Supply & Demand, by MATT QUINN

A recent study from the Blue Cross and Blue Shield Foundation on Health Care and the Schneider Institute for Health Policy at Brandeis University has concluded that Emergency Rooms Overcrowded Due to Poor Contact With Doctors . It seems that, especially among folks with chronic conditions like congestive heart failure, pneumonia, chronic obstructive pulmonary disease, asthma, hypertension and diabetes, regular physician contact is a big factor in reducing ED utilization and costs. Imagine that!

But other study findings point to the difficulty that fully-insured plan members have in accessing their physicians:

    “One in five ED visits were for selected low acuity conditions…such as sore throat and minor rashes. These are visits that can generally be safely treated in a physician’s office. The single most important contributor to the overall ED cost per member is the increasing proportion of members (10 percent) using the ED at least once.”

Added Blue Cross and Blue Shield Association Chief Medical Officer Allan Korn, M.D:

    “Because the privately insured account for more than half of the recent growth in emergency department utilization, there may be ways to address the problem upstream and not just focus on the supply side…This new study provides a balance in understanding supply and demand issues and also sheds an important light on potential areas where insurers and physicians can work together to provide better patient care in more appropriate and less costly settings.”

The opportunity for secure patient-physician email communication of the type that RelayHealth provides part of the solution to this problem. Perhaps a “potential area where insurers and physicians can work together” is by following the lead of Blue Shield of CA and others in establishing rules and reimbursement for such service .

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