Title: Amerigroup ED Alternatives Program
Organization Name: Amerigroup
Innovation Type: Care Connections
What They’re Doing: Connecting members who frequently utilize Emergency Department (ED) services with after-hours primary care or urgent care that can serve as an alternative to services provided in the ED .
Clinical Innovation: The program increases access to after-hours care by creating network of urgent care clinics and primary care physicians willing to see patients in the evenings and on weekends. All Amerigroup members are informed of these local alternatives to emergency care through letters and after hours directories. Phone calls from staff are made to members with three or more emergency room visits. All members with 7 or more emergency room visits receive a phone call from a mental and behavioral health specialist. The program also offers clinical triage and referral phone service (“Amerigroup On Call”) that is available to members around the clock. Members who call will be able to speak with a nurse and/or a physician who will discuss the medical issue and advise the patient to schedule a visit with their primary care physician, refer him/her to an urgent care center, connect him/her with an appropriate physician or direct him/her to the nearest emergency room.
Supportive Financing Mechanism: Primary care physicians participating in the program are offered an enhanced fee for service reimbursement for all after hours care provided.
Evaluation Type: Quasi-Experimental
Evaluation Plan: Evaluating the program based on a comparison of emergency room visits before and after the implementation of the program.
Patient Health and Cost Outcomes:
Emergency room utilization decreased from 760 visits per 1,000 members in 2009 to 720 emergency room visits per 1,000 members (after adjusting for H1N1) in 2010, a 5% decrease year over year, reducing the number of non-emergency visits and shifting utilization to urgent care centers and primary care physician offices.
Urgent care clinic visits increased from 72/1,000 in 2009 to 115/1,000 in 2010, a 60% increase.
Target Population: Amerigroup members who frequently seek care in the Emergency Department setting.
Date of Implementation: 2010
Contact: Kathleen Loughran, firstname.lastname@example.org
Where to learn from: