The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

 

The Newly Insured Don’t Turn into Primary Care Physician (PCP) Loyalists Overnight

By Truven Staff
Linda MacCracken imageWhen looking at the impact of the newly insured, the Philadelphia market’s experience of an 8% rise in emergency department (ED) use is notable. Moving from uninsured to insured status may happen in a day, but new health service use habits take time. The impact of the newly insured – via Medicaid expansion or private exchanges – is still unfolding.

Truven Health forecasts on the impact of the newly insured mirror the statistics noted in the Philadelphia Inquirer article, “.” In fact, young adults and children are more likely to use an ED when they have insurance versus when they had less insurance. Surprisingly or not, children, Millennials and young Gen Xers are not primary care physician (PCP) loyalists.

“What to Expect from the Newly Insured” to get highlights on what to expect, tips on how to prepare, and how to realize higher profits and deeper customer engagement.

Linda MacCracken
Vice President, Advisory Services

Smart Use of Urgent Care Helps Consumers, Providers, and Payers Win

By Truven Staff
Linda MacCracken imageConsumers – people like us, our parents, and our children – , making healthcare difficult to obtain. When you can take three vacations in the time that you’ll wait to see a doctor, something is really wrong. The magic of the Internet – online Skype appointments and iPhone diagnostics – lacks assurance that something dire hasn’t been missed. This is why doctors train, get credentialed, and ‘practice.’

Providers with smart, extended footprints are doing more. Our data shows that over the next five years, demand for after-hours care in some markets can grow 35%, versus a 22% demand growth for overall Emergency Department (ED) care. The newly insured’s younger enrollees – those under 35 – will use the ED twice as often as when they were uninsured. Nationally, 62% of ED visits are urgent, suggesting that at least one in three can be seen elsewhere.  

Payers are concerned that 70% of ED visits are avoidable, and they can save the $1100/visit by redirecting ED patients to lower-cost sites, such as urgent care centers. Urgent care is right for patient demand, good for the provider access, and effective for payers seeking to contain costs.

and improve patient experience calls for delivering the right service, in the right market, with the right access.

Linda MacCracken
VP, Advisory Services

Generations Connect Differently to Primary Care Providers (PCPs)

By Truven Staff
Linda MacCracken imageA recent article in InformationWeek, "," discusses what "quality of care" means to different generations and how this can affect Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results. Based on information from the Truven Health PULSE™ Healthcare Survey, we’ve found that Millennials and Boomers select and connect to primary care providers (PCPs) differently. Baby Boomers are more likely (90%) to have regular PCPs than Millennials (66%). Millennials select PCPs based on these criteria: quality (33%), caring (25%) and communication (22%). Baby Boomers select PCPs differently for communication (33%), quality (27%), and caring (23%). Most Baby Boomers (92%) have had the same PCP since the prior year, as have Millennials (88%), although to a lesser extent.

Clearly these differences favor unique pull-through strategies once the right content, such as quality and satisfaction feedback, is put into the right hands, of the right generation, in the right way.

Linda MacCracken
Vice President, Advisory Services

Emergency Departments are in the Center of the Healthcare Reform Storm

By Truven Staff
Linda MacCrackenThe recent New York Times article, , discusses the cost of an Emergency Department (ED) visit. EDs are under intense scrutiny by all parties – payers, employers, providers, and the government – about cost, quality and patient-engaged care. In fact, nationally, 62% of ED visits are urgent care (not emergent), making them more of a “department of available medicine” than necessary. This varies across the country,  where some markets show ED usage at 42% urgent visit share, while others tower north of 90%. Avoidable visits or overuse are typical of both Medicaid/self pay and commercially insured individuals. A national savings of $4.4 billion is possible if 20% of ED visits are redirected to an alternative or lower-cost care site.

Reform-based Medicaid expansion implies more demand for EDs, and requires adequate actual or virtual capacity. The opportunity is to provide alternative care settings. Some providers have had success in offering preventive screening physicals, care at urgent care centers (that accept insurance) and direct one-one patient engagement. One health system was able to reduce ED business by $1.5 million in Medicaid/self pay by reaching out to “frequent fliers” (5 or more ED visits per year) and educate them that the ‘next time,’ they can get the same or more appropriate care at a community health clinic. Providing the right capacity for the right care type in the right service setting goes a long way to protect the ED for the truly medically needy.

Commercially insured patients can also over-use the ED. 29% of employer-paid commercially insured patients, presenting with both an unavoidable and emergent condition, belong in the ED. 42% could have been cared for in a primary care setting. The net savings for redirecting commercially insured visits to a physician office setting is $1171 per visit. This invites a structure for an urgent care service line in physician offices.

The New York Times article states that compared to alternative outpatient care, the price of an ED visit is high, especially from the view of the cost-accountable consumer. However, EDs provide crucial health services, and there is a price for those life saving resources. What types of care belong in the ED is another matter that underscores its role at the eye of the storm of shifting outpatient care. All stakeholders – payers, employers, consumers, the government, and providers – are participating in the shift.

For more details, please download one of these publications.
, Dunn, MacCracken, 2012
, HealthLeaders Media Fact File, October 2013

Linda MacCracken
VP, Advisory Services

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