In 2018, there were 130 million emergency department (ED) visits in the U.S., but according to a recent study, fewer than half were clinically emergent. These visits totaled more than $150 billion, but majority either did not require ED resources or could have been avoided with better primary care. Reducing these visits presents a critical opportunity to curb costs and avoid adverse outcomes.
Learn how AI can help to reduce avoidable ED utilization, improve chronic care management, and promote care continuity. Discover how AI can help to predict declining health due to chronic conditions, identify barriers to care that may arise from social determinants of health, and pinpoint disconnects in the care continuum.
Data extracted from health insurance medical claims with details about dates and place of service, diagnosis codes, key procedures, use of medical equipment, and provider specialties.
Self-reported data from health questionnaires that assess a person’s individual medical history, health risks, lifestyle, health behaviors, and quality of life.
Geo-centric data with details about the social and environmental influences on people’s health and outcomes.
ClosedLoop generates explainable predictions using
thousands of auto generated, clinically relevant contributing factors
In 2018, there were 130 million emergency department (ED) visits in the United States, the equivalent of 40.4 ED visits per 100 people.¹ According to a recently revised algorithm to assess ED visit severity, less than half were clinically emergent. The majority either did not require ED resources or could have been avoided with better primary care. An estimated 33% of visits were non-emergent, 20% were primary care treatable, and another 4% needed the ED but were potentially avoidable. These visits cost an average of more than $2000 individually, and the total cost exceeded $150 billion.²
Such high levels of avoidable ED visits occur for multiple reasons, including poor chronic disease management, insufficient care site alternatives, lack of adequate primary care access, or other significant barriers to care.³ More than half of frequent ED utilizers have at least one chronic condition, and patients living in the lowest income communities represent roughly one-third of aggregate ED visits and costs.⁴⁻⁵ Preventing ED visits in older adults is particularly noteworthy, since a trip to the ED for an older adult can often be a tipping point; ED utilization by older adults increases risk of developing a potentially permanent disability by roughly 15%.⁶⁻⁸
Predictive analytics present an opportunity to proactively identify individual patients at high risk for avoidable ED visits. This insight can enable care teams to identify and address potential issues and support initiatives to improve chronic care management, promote care continuity, and address barriers to care. Armed with AI, providers will be in a position to reduce avoidable ED visits, lower costs, and improve health outcomes.
1 National Center for Health Statistics. Emergency Department Visits. Emergency Department Visits. Published 2021. Accessed March 22, 2021. https://www.cdc.gov/nchs/fastats/emergency-department.htm
2 Lemke KW, Pham K, Ravert DM, Weiner JP. A Revised Classification Algorithm for Assessing Emergency Department Visit Severity of Populations. The American Journal of Managed Care. 2020;26(3). https://www.ajmc.com/view/a-revised-classification-algorithm-for-assessing-emergency-department-visit-severity-of-populations
3 Dowd B, Karmarker M, Swenson T, et al. Emergency Department Utilization as a Measure of Physician Performance. American Journal of Medical Quality. 2013;29(2):135-143. doi:10.1177/1062860613487196
4 Capp, Roberta, et al. “Coordination Program Reduced Acute Care Use and Increased Primary Care Visits Among Frequent Emergency Care Users.” Health Affairs, vol. 36, no. 10, Oct. 2017, doi.org/10.1377/hlthaff.2017.0612. Accessed 4 Mar. 2021.
5 Moore, Brian J., Liang, Lan. “Statistical Brief #268: Costs of Emergency Department Visits in the United States, 2017.” Agency for Healthcare Research and Quality, Dec. 2020. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb268-ED-Costs-2017.pdf. Accessed 4 Mar. 2021.
6 NCOA. “Healthy Aging Facts.” National Council on Aging, 10 Jul. 2018, https://www.ncoa.org/resources/fact-sheet-healthy-aging/. Accessed 4 Mar. 2021.
7 Graham, Judith. “For Elder Health, Trips To The ER Are Often A Tipping Point.” Kaiser Health News, 11 Jan. 2018, khn.org/news/for-elder-health-trips-to-the-er-are-often-a-tipping-point/. Accessed 4 Mar. 2021.
8 Nagurney, Justine M., et al. “Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons.” Annals of Emergency Medicine, vol. 69, no. 4, Apr. 2017, pp. 426–433, 10.1016/j.annemergmed.2016.09.018.