Insurer Works to Help Members Choose Between Urgent Care and the ED

Typically, going to the emergency room costs a lot more than a trip to an urgent care center for the same complaint. You’d think insurers would be invested in getting their plan members to recognize the difference and make informed decisions accordingly. The chief medical officer of Innovation Health agrees, and revealed a “decision tree” to help patients choose wisely—and economically. Sunil Budhrani, MD, an emergency room doctor for close to 20 years who went on to found a telemedicine company before joining Innovation, says urgent care centers are simply better options all around for many acute, non–life-threatening complaints and is “amazed” that so many patients still wind up in the ED because they have a sore throat. The decision tree, which works like a clinical algorithm, asks patients whether they have symptoms such as chest pain or shortness of breath (among others associated with truly emergent events), followed by a second set of criteria that point them to either the ED or an urgent care center. It also cites data from various studies explaining the cost- and time-saving benefits of urgent care. Budhrani points out that being co-owned by a major health system (Inova) and an insurer (Aetna) gives the unit a unique perspective, access to patients, and the resources to educate patients properly (as well as a financial incentive to both save money and collect fees, of course). While individual urgent care operators don’t have the same resources, they can convey the same message using the same media—eg, mail and social media.