Emergency Room Diversion Program

Emergency Room Diversion Program

According to the Centers for Disease Control and Prevention (CDC), Americans make more than 139 million visits to the emergency room (ER) each year. About half of these visits involved chronic conditions, primarily related to heart disease and diabetes many of which could have been prevented with proper condition management and ongoing care from a primary care physician (PCP). 

The ER Diversion Program uses a proactive strategy to decrease ER overutilization. Members with two or more visits to the ER within three months are automatically enrolled in the program and receive outbound calls from an ER Care Guardian advocate. The ER Care Guardian aims to shape the habits of high utilizers and reduce ER visits by:

• Identifying reasons for high ER utilization to address and remove barriers to getting appropriate care.
• Providing education on alternatives to the ER for non-emergent issues.
• Educating the member on the importance of getting routine health care through a medical home.
• Motivating members to partner with a PCP and assisting those who need help locating a PCP or patient-centered medical home (PCMH).
• Making referrals to Population Health programs that may benefit the member. These programs include:
  • Lifestyle/wellness care management (tobacco cessation, weight management, etc.)
  • Chronic condition care management
  • Acute medical case management
  • Behavioral health care management
• Making referrals to community resources to help eliminate barriers to condition management such as:
  • Transportation to doctor’s appointments
  • Prescription assistance programs
  • Financial assistance programs
  • Targeted community support services