New analysis provides key insights into access to care challenges and opportunities
Denver, CO – Today, the Department of Health Care Policy & Financing (Department) issued a first-of-its-kind analysis of emergency department (ED) utilization (sometimes called Emergency Room) among Health First Colorado (Colorado’s Medicaid program) members. High rates of non-emergency ED utilization can be costly but more importantly, they also can be indicators that members may have difficulty accessing preventive care, face challenges managing chronic conditions, or experience unmet social and economic needs (e.g., stable housing) that exacerbate health conditions.
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Identifying those issues enables the Department and its Regional Accountable Entities (RAEs) to work with providers and members to find opportunities to improve health outcomes while saving Coloradans money on health care.
“Reducing non-emergency ED use has been, and will continue to be, a focus of the Department. It requires a nuanced understanding of the complex reasons why people go to the ED,” said Kim Bimestefer, executive director of the Department. “This report will help the Department and our partners better understand which members are using the ED, why they choose to go to the ED instead of their primary care doctor, and what barriers to primary care they may be experiencing. These insights will help us design more effective access and health improvement strategies going forward.”
Since 2018, the Department has tracked ED utilization at the RAE level because RAEs are responsible for coordinating member care and ensuring members are connected with primary and behavioral health care. The RAEs are tasked with developing strategies that respond to the needs of members in their region in collaboration with the Department.
According to the report, each year, about 25% of Health First Colorado members rely on the emergency department for care at some point. The reasons members use the ED are as diverse as the Health First Colorado population itself. Some key findings from the analysis include:
- Four percent of members went to the ED six times or more in a 12-month period and accounted for more than 20% of ED visits. A substantial portion of this group was unhoused.
- Potentially preventable ED visits, such as uncontrolled diabetes, comprise a small percentage of overall ED visits (5%); however, these conditions can often be treated and managed more appropriately in primary care settings.
- Other reasons members end up in the ED for potentially preventable visits include limited access to after-hours care, work and transportation challenges, cost and efficiency reasons, and even perceptions that the ED may provide better care.
- Pregnant members tend to have higher ED utilization rates on average, while children have among the lowest ED utilization rates.
- Reasons members went to the ED changed during the pandemic
- While respiratory infections declined substantially during the early months, ED visits for substance use issues became more common during the first year of the pandemic.
- Mental health emergencies for teenagers and children in foster care also presented in the ED, though more analysis is needed.
The report outlines several challenges and opportunities for reducing ED utilization while promoting high-quality care in the appropriate setting. Examples include what RAEs, providers, and community groups have done to implement targeted efforts particularly for people with chronic conditions and unmet housing needs. The report also includes detailed appendices with ED utilization for specific member groups. The Department will continue to track ED utilization to identify how trends may change over time.
This press release was provided by the Colorado Department of Health Care Policy and Financing.