Innovative Program Helps Redirect Health Care Needs From the Emergency Room to the...

Innovative Program Helps Redirect Health Care Needs From the Emergency Room to
the Doctor's Office
Anthem Blue Cross and Blue Shield in Indiana program aids in linking Hoosier
Healthwise members to primary care physicians for preventive care

INDIANAPOLIS, Sept. 2 /PRNewswire/ -- According to a recent government
study, over a 10-year period, emergency room visits have increased by 20
percent. By contrast, the number of available hospital emergency rooms in the
same time period has decreased. In an effort to help ensure Hoosier Healthwise
(HHW) members establish a medical home with their primary care physician for
preventive care, Anthem Blue Cross and Blue Shield in Indiana is piloting the
ER Initiative Program, an innovative program aimed at reducing the number of
unnecessary visits to the emergency room.
According to the Partnership for Medicaid, almost 20 percent of all
emergency room visits are made by Medicaid beneficiaries, and in 2003 Medicaid
spent an estimated $8 billion for 22 million hospital emergency room visits.
Anthem's ER Initiative Program is being piloted in Evansville, where it
serves nearly 10,000 Medicaid managed care members. In the six months since
introducing the pilot program, Anthem has already seen an approximate 6-9
percent decrease in the number of visits to the emergency room by its HHW
members. Nearly five years ago, the same program was implemented by Anthem's
affiliate in California; today that program still boasts decreases in
unnecessary visits to the emergency room by its Medicaid members.
The growing healthcare costs are prompting many states to ask managed care
organizations for ways to help manage those costs, while ensuring Medicaid
beneficiaries have the needed access to health care.
While collaborating Deaconess Hospital to track and trend emergency room
visits, Anthem's Community Resource Center staff discovered an unusually high
rate of visits by Anthem members at each of the hospitals. To help identify
the root cause of the visits, an Outreach Specialist conducted on-site
interviews of members at the time of their discharge from the emergency room
to understand what brought the member to the emergency room, and if their
medical need could have been addressed by their primary care physician.
"Our ability to capture this information in real time as the member was in
the emergency room is an important part of our program," said Dr. Stanley
Reed, medical director for Anthem Blue Cross and Blue Shield in Indiana.
"Through a series of questions we're able to determine if the member has seen
their primary care physician; if not, why they haven't; and, more importantly,
what medical need brought them to the emergency room." Many times the
conditions that brought members to the emergency room could have been treated
by their physicians, or preventive measures could have avoided a visit to the
emergency room. In addition to the real-time interactions, Anthem conducted
member outreach and education in the days following their emergency room visit
to ensure they knew how to access their primary care physician for follow up
and future medical care.
Additionally, the data Anthem found was very similar to national
statistics for emergency room use. "Among the variety of medical conditions
that brought our members to the emergency room, the majority were abdominal
pain, chest pain, fever and cough," added Reed.
"This program is a testament to the personalized care Anthem's Community
Resource Centers offer Hoosier Healthwise members," said Rob Hillman,
president and general manager for Anthem Blue Cross and Blue Shield in
Indiana. "In addition, this program demonstrates an innovative approach that
helps to eliminate unnecessary costs in our health care system by providing
the right level of care at the right time for our members."
About Anthem Blue Cross and Blue Shield in Indiana
Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance
Companies, Inc., an independent licensee of the Blue Cross and Blue Shield
Association. (R) ANTHEM is a registered trademark of Anthem Insurance
Companies, Inc. The Blue Cross and Blue Shield names and symbols are
registered marks of the Blue Cross and Blue Shield Association. Additional
information about Anthem Blue Cross and Blue Shield in Indiana is available at
www.anthem.com .
SOURCE Anthem Blue Cross and Blue Shield in Indiana

Leslie Porras, +1-805-557-6745, leslie.porras@wellpoint.com, for Anthem Blue
Cross and Blue Shield in Indiana