Knowing where to go for care not only saves unnecessary medical costs, it is also key to the best care

The emergency room (ER) plays an important role in providing immediate care for individuals with serious health conditions or urgent health crises. And while they focus on helping people in dire situations, ER staff also spend a significant amount of their precious time treating patients who could have been more efficiently and effectively served by their primary care doctor. It is estimated that in the U.S., 13 to 27 percent of ER visits annually could be managed in alternative settings such as primary care clinics, which could result in savings of $4.4 billion in medical costs.

ER visits for non-emergencies happen for many reasons. Sometimes people ignore a minor a health problem until it becomes an emergency. In other cases, a patient simply doesn't know which health conditions truly require a trip to the ER. Data shows that among the reasons people on Medicaid visit the emergency room, conditions including headaches, urinary tract infections and back pain, are quite common; across the U.S., similar patterns exist for children visiting the ER.

When a person visits the ER for care that is not a true emergency, it impacts everyone. By going to the ER, a patient may unnecessarily tie up ER doctors and resources, making it harder for people who have a more immediate need for care to access emergency care quickly. They may also receive unnecessary tests and treatments. But, importantly, a patient may be missing out on the high-quality experience they could receive from their primary care doctor, who is aware of the patient’s medical history.


Part of our role in building healthier communities is to help our members to be more informed about their health care choices. Through an analysis of claims, we learned that 35 percent of ER users were unaware that they had alternatives for care.  To help resolve this knowledge gap, we’ve created an educational portal for consumers and members that reinforces how to receive the best care and how to stay connected to their primary care doctor. Articles and checklists help visitors understand the conditions that truly need emergency room care. Visitors also can view a video and participate in a quiz to better understand which care setting – primary care doctor, urgent care or ER – is best equipped to provide the care they need.

While some serious conditions will always require a visit to the emergency room, we aim to reduce ER utilization for non-emergent situations, and ultimately help everyone get better care. Learn more about Community & State's efforts to build better awareness of care options at http://www.uhc.com/KnowWhereToGoForCare.

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