Improve Utilization

Improve Utilization Management

Our solutions can be applied across sites of care redirecting  members to lower cost options without compromising outcomes.

ER

Estimated
$35 billion
spent annually on low acuity ER visits that could be redirected to telehealth.

Telehealth

The COVID pandemic has created significant adoption of telehealth. Recent estimates show the potential of
$250 billion
in the virtual care market.

ER

Estimated $35 billion spent annually on low acuity ER visits that could be redirected to telehealth.

Telehealth

The COVID pandemic has created significant adoption of telehealth. Recent estimates show the potential of $250 billion in the virtual care market.


Emergency Room (ER) Reduction

Members with low acuity conditions frequently go to the emergency room for treatment instead of turning to alternative care settings such as telehealth, primary care physicians, or urgent care centers. This is inconvenient for the member and costly for the health plan, with estimated avoidable ER costs totaling an estimated $35 billion annually.

  • Each year, more than 130 million people visit emergency rooms. Most studies find that at least 30% of emergency room (ER) visits are not urgent. Overcrowding in ERs is a costly and concerning problem, compromising patient care quality and experience
  • Two-thirds of ER visits are avoidable. That translates into nearly 20 Million trip to the Emergency department and an estimated $35 Billion in costs to the health bare system each year.
  • The average cost of treating nonemergency conditions in the ER is $2,032, which is $1,800 more than in primary care settings.

Sources Centers for disease control and prevention (CDC) National Alliance on Mental Illness (NAMI) Mckinsey & Co. Ernst & Young UnitedHealth Group

NextHealth’s ER Reduction Solution


Our ER Solution has a proven track record of redirecting members to lower cost care options.  We start by predicting which members will use the emergency room when a lower acuity (and cost) care site would be appropriate. Then, NextHealth determines which of these members are impactable and worthwhile outreach targets. We then break the targeted population into cohorts, further breaking them into trials and control groups.  Working with our partners, carefully crafted messages and nudges are delivered to the trial population – all while we monitor the results, and test and learn our way to optimal results.


The Result

We partnered with one of the nation’s largest healthcare payers to activate members into virtual behavior care. The plan saw a 33% increase in telehealth saving approximately $8 per member per month from avoidable ER visits.

Telehealth


Current telehealth adoption trends present a dramatic opportunity for health plans to increase access, plus improve cost and quality outcomes. But, given low historical utilization of telehealth, your plan may still be early in the analytics maturity without a strategy for optimizing. 

NextHealth’s Telehealth Solution.


Our Telehealth Solution provides a roadmap for your plan to develop and implement a telehealth strategy. We start by analyzing current telehealth utilization including changes pre- and post- pandemic. From this analysis we then identify areas for telehealth amplification, launch campaigns, and then quantify the financial results we are seeing from our partnership.  

  • The telehealth revolution has transformed how doctors and patients interact. At the height of the Covid-19 pandemic, between 50% and 80% of medical visits were conducted via telemedicine, up from just 1% before it. There are many benefits to this trend — access to necessary care, increased convenience, the potential to reduce clinical overhead costs, and improved health outcomes.  
  • According to some projections, if the adoption of telehealth across consumers and providers continue to expand, the virtual care market has a potential to grow up to $250B. 

Sources: Centers for disease control and prevention (CDC)
National Alliance on Mental Illness (NAMI) Mckinsey & Co.
Ernst & Young
UnitedHealth Group

The pandemic has challenged preconceived notions of how health care needs to be delivered and has eliminated existing barriers to digital health adoption. Health systems and physicians learned how to successfully deliver remote care and consumers have seen firsthand how health technologies can simplify, enhance, and personalize their care experiences.

Payers need to take actions to take advantage of these trends to continue the adoption of virtual care services across their member populations and provider community. They need to take a data driven approach to drive penetration of telehealth in clinical areas where there is most cost savings opportunity. They need to focus on members that are most likely to benefit from virtual care interventions. Our Telehealth Solution enables payers to take advantage of trends in adoption of virtual care services across their member populations and provider community. We provide a data driven approach to drive penetration in clinical areas with the most savings opportunity and focus on members who will most likely benefit from virtual care interventions.


The Result

After partnering with a mid-sized regional health plan, NextHealth’s analysis showed that there were initial significant opportunities for savings including promoting telehealth for behavioral health, diabetes care and as an alternative to the ER. NextHealth revealed groups that the health plan could target with campaigns and incentives to increase telehealth use.

Our solutions are helping transform healthcare