2017-05: Notice of Emergency Room High Utilizers

Date: 02/21/17

As part of our continued commitment to supporting our provider partners in delivering quality care for our members—your patients—Louisiana Healthcare Connections will provide you with timely notifications of Emergency Room (ER) High Utilizers.

High utilizers are defined as members who have three or more ER visits in a 90-day period. When a member assigned to your patient panel is identified as a high utilizer, you will be provided with a notification that will include:

• Member identifier
• The total number of ER visits
• The timeframe of ER visits
• The primary reason for the visits

Effective February 21, 2017, notices will be faxed to you as soon as the information regarding the ER visit is available.

We encourage you to use this information as an opportunity to schedule follow-up care with your patient and to provide them with education about appropriate ER use. Louisiana Healthcare Connections offers many resources and tools to assist you and your patients – our members - in reducing non-emergent ER visits, including:

• Care Management services for direct outreach and education for members
• A member-focused guide, “The Right Care at the Right Time from the Right Place,” to educate patients about when to visit a PCP, Urgent Care Clinic or an ER
• A provider-focused guide that includes tips and best practices for reducing ER visits as well as descriptions of operational incentives for increasing reimbursement rates
• Member access to a 24/7 nurse advice hotline for basic health education, nurse triage and answers to questions about urgent or emergency care access
• Provider referrals to our MemberConnections® or Chronic Care Management programs