Anthem Blue Cross and Blue Shield launches initiative to educate consumers on how to best access ER alternatives

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Jul 22 2010

At a time when health care costs continue to rise and hospitals are advertising emergency room availability, it is becoming more important to educate consumers on how to best access ER alternatives and receive the same care with less out-of-pocket cost. If a primary care physician isn't available, retail health clinics, walk-in doctor offices and urgent care centers can take less time and cost about the same as a regular doctor visit.

Anthem Blue Cross and Blue Shield in Virginia has recently introduced a series of tools designed to provide consumers with the information they need to make the best decision when it comes to seeking treatment.

"Traditionally, emergency room visits are some of the most expensive episodes in the health care industry," said C. Burke King, president, Anthem Blue Cross and Blue Shield in Virginia. "By utilizing technology to provide general education in innovative ways, we can help our members make better educated health care decisions and be better stewards of their health care dollar."

A study of Anthem claims data for its fully insured business found that more than 60 percent of ER visits for its members were in the area of avoidable visits, or diagnoses that potentially could have been treated in urgent care centers. As an example, bronchitis, one of the more expensive conditions to treat, costs on average $646 to treat in the ER, compared with $97 for an urgent care visit and $54 for a retail health clinic visit. Average costs for visits for all conditions studied ranged from $441 for the ER to $98 for urgent care and $52 for retail care. These costs represent total costs, including the portion paid by the health plan member. In 2008 according to statehealthfacts.org, there were more than 3 million total ER visits in Virginia.

Anthem has created a Google Map that identifies all of the ER alternatives (retail health clinics, urgent care centers and walk-in doctor offices) throughout the state so members have this information at their fingertips. To access the information, please visit http://www.anthem.com/eralt or simply type "Anthem urgent care" into Google or Bing. A link to the information is also available on the "member" home page at www.anthem.com. Physicians can access these maps also in order to quickly help direct their patients to the best care based on their specific situation.

In addition to utilizing the information on the company's website, members with the 24/7 NurseLine benefit can also contact an Anthem registered nurse to learn the best place to seek care for their medical problem they are dealing with.

Manish Oza, M.D., Anthem medical director and practicing ER physician, said, "By leveraging technology and cataloging all the necessary information, Anthem's nurse hotline can effectively triage members and provide them with all of their choices ultimately for the member to decide the appropriate venue for care."

Not only is Anthem providing resources for members to utilize, the company is also leveraging proactive communications like interactive voice recognition calls and e-mail messaging to inform members of options. An iPhone application will launch later this year.

"We plan to leverage technology in multiple ways to touch members when they visit an ER for an avoidable visit without being intrusive," said Oza.

Generally, urgent care clinics may be used for the following and retail health clinics in certain circumstances: