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Member Research and Reports

Member Research and Reports

UAB: Reducing Emergency Department Visits Among Dual Eligible Patients via a Comprehensive Wellness Assessment

Reducing avoidable emergency department (ED) use is a major priority for organizations seeking to control waste and inefficiency in the health care delivery system. The objective of this paper was to assess whether a Comprehensive Wellness Assessment (CWA) is associated with reduced emergency department (ED) visits for Special Needs Program (SNP) enrollees with diabetes.

A team of researchers that collaborated on this study are Dr. Bisakha Sen, Department of Health Care Organization and Policy at the University of Alabama at Birmingham School of Public Health, Dr. Barbra Guerard, Peoples Health, and Dr. Vincent Omachonu, Department of Industrial Engineering, University of Miami.

According to the Centers for Disease Control and Prevention (CDC), there were 141.4 million ED visits in 2014, which represents a 10 million visit increase from 2013. This study seeks to expand on previous research to determine if a Comprehensive Wellness Assessment (CWA) program was producing additional benefits related to an overall decrease in health care costs, specifically as it related to ED use by the Medicare Advantage (MA) plan’s most vulnerable population – the dual eligible Special Needs Program (SNP) enrollees. Dual eligibles continue to capture the attention of health care policy makers at both the federal and state levels because delivery of care for this population creates unique challenges on many fronts.

In summary, findings from this research indicate that the completion of a CWA appears to be an effective method to reduce ED utilization among dual eligible members with diabetes in this study sample. Thus, this study provides important information on reducing ED utilization in a dual eligible population with a chronic condition.

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