Project Description

Problem: Excessive ER Visits

At a six-month plan evaluation meeting, the Advisor and Stirling Benefits representative reviewed all ER visits. Asked and answered: Why are members going to the ER? What is the diagnosis? Who are the frequent ER users? Why do they go?

The Stirling Solution

  • In one case, we found that the same family had used the ER five times in a six-month period, one of those visits was for a child with an earache. We reached out to that member and explained the telemedicine benefit was available and how convenient it was to use. We helped them connect with a local clinic that could provide treatments for non-emergency situations.

  • The plan made a mid-year correction and changed the ER copayment from $150 per visit to a tiered structured copay $150 for the first visit, $300 for all subsequent visits for the same family member. The next year the plan decreased the copayment for the local clinic from $30 to $20 per visit.

  • Educated all members about the change and alternatives to the ER. Family started using the clinic as their “ER” and were satisfied with the immediate care provided.


ER visits cut in half after the mid-year plan change.
Savings approximately in a six month period for this 75 employee plan