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Health First Colorado Releases Analysis of Emergency Department Utilization – State of Reform

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New analysis provides key insights into access to care challenges and opportunities

Denver, CO – Today, the Department of Health Care Policy and Financing (Department) released a never-before-seen analysis of use of emergency services (ED) (sometimes called an emergency room) among members of Health First Colorado (Colorado’s Medicaid program). High rates of non-emergency emergency service use can be costly, but more importantly, it can also indicate that members may have difficulty accessing preventative care, facing challenges managing illnesses chronic conditions or experiencing unmet social and economic needs (eg, stable housing) that exacerbate health conditions.

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Identifying these problems allows the Department and its Responsible regional entities (RAE) to work with providers and members to find opportunities to improve health outcomes while saving Colorados money on health care.

“Reducing the use of non-emergency emergency services has been and will continue to be a Department priority. It requires a nuanced understanding of the complex reasons why people go to the ER,” said Department Executive Director Kim Bimestefer. “This report will help the Department and our partners better understand which members are using the ER, why they choose to go to the ER instead of their primary care physician, and what barriers to primary care they may be experiencing. This information will help us design more effective health access and improvement strategies in the future.

Since 2018, the Department has been tracking emergency service utilization at the RAE level, as RAEs are responsible for coordinating member care and ensuring members are connected to primary and behavioral health care. The RAEs are mandated to develop strategies that meet the needs of members in their region in collaboration with the Department.

According to the report, approximately 25% of Health First Colorado members rely on the emergency department for care at some point each year. The reasons members use the emergency department are as diverse as the population of Health First Colorado itself. Here are some of the main conclusions of the analysis:

  • Four percent of members visited the ED six or more times in a 12-month period and accounted for more than 20% of ED visits. A significant portion of this group was homeless.
  • Potentially preventable ED visits, such as uncontrolled diabetes, represent a small percentage of all ED visits (5%); however, these conditions can often be treated and managed more appropriately in primary care settings.
  • Other reasons why members end up in the emergency room for potentially avoidable visits include limited access to after-hours care, work and transportation challenges, cost and expense reasons. efficiency, and even the perception that the ED can provide better care.
  • Pregnant members tend to have higher rates of emergency department use on average, while children have some of the lowest rates of emergency department use.
  • The reasons members went to the ER changed during the pandemic
  • While respiratory infections dropped significantly in the first few months, emergency room visits for substance use issues became more common in the first year of the pandemic.
  • Mental health emergencies for adolescents and foster children are also featured in the ED, although further analysis is required.

The report outlines several challenges and opportunities for reducing emergency department use 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 emergency service usage for specific member groups. The Ministry will continue to monitor emergency department use to determine how trends may change over time.

This press release was provided by the Colorado Department of Health Care Policy and Funding.