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.

Savings

0%
ER visits cut in half after the mid-year plan change.
$0
Savings approximately in a six month period for this 75 employee plan