Healthcare Navigation: Emergency Rooms Versus Urgent Care

06/11/2024 Written by: AP Employee Benefits

As healthcare costs continue to rise for employers and employees alike, it is important to educate your employees on the different ways they can alleviate some of those costly out-of-pocket medical expenses. One way that employees can have a direct impact on their medical costs is by knowing when to use urgent care centers and what warrants a visit to the emergency room. These two centers of care have significant situational and cost differences that can have a real impact on both the employee and employer.

According to the National Library of Medicine, there are several reasons why patients choose to access emergency and urgent care centers, including limited access (or confidence) in primary care, the patient's perception of emergency, and convenience of care. With ER visits costing over ten times the rate of urgent care centers, many employers are considering the importance of responsible healthcare consumerism within their employee population.

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Situational Differences

When unexpected medical needs arise, it is important for employees to know which care center is the best option for them based on their current circumstance. Many studies have shown that over 30% of all emergency department cases are non-emergent, leading to increased costs for both the employee and the employer, not to mention longer wait times and decreased satisfaction in care. Urgent care centers can be much more suitable to non-life-threatening conditions that still require prompt attention such as injuries resulting in cuts or broken bones, food poisonings, cold or flu symptoms, or infections. Urgent care centers are designed to bridge the gap between an employee's primary care practice and the emergency room. These centers can provide an employee a convenient and efficient option to get the medical attention they need. When their primary care options are closed or booked out, urgent care facilities can provide a convenient, cost-effective avenue for employees to receive non-emergent care.

On the other hand, emergency rooms are better equipped to handle more serious and life-threatening scenarios that an employee may face. Emergency departments are typically fully-staffed with physicians, specialists, and nurses trained in around-the-clock emergency care. They have on-site diagnostic, imaging, and laboratory services, access to specialists in several fields including cardiology, pediatrics, and orthopedics, and direct access to pharmacy services, if needed. For heart attacks, strokes, severe injuries or trauma, the emergency room is oftentimes the best place for the patient to receive care.

Cost Differences

From a cost perspective, there can be a significant difference between the two facility options. In many cases, an urgent care facility can be significantly less expensive than an emergency room visit due to the lower overhead costs of staffing and operating the urgent care center. According to AccessMD Urgent Care, the average urgent care visit costs patients between $71 and $125 for basic care and patients are typically seen as quickly as within fifteen minutes. Conversely, the average emergency room visit costs $1,318 with an average wait time of 2.4 hours. These additional visits can accumulate to an additional a national 18 million avoidable ER visits annually, accounting for $32 billion in additional costs to the healthcare system among commercially insured individuals. For many employers, it can be beneficial to educate employees on the difference in this difference between the two care options. Not only do these centers typically result in a far less significant bill to the employee due to reduced out of pocket expenses, there is also far less of an impact to the plan sponsor's bottom line.

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Healthcare Navigation Education

It is important for employers to educate their plan members on the best ways to navigate the complex healthcare system. Many plan sponsors have adopted healthcare navigation tools as a front line mechanism to guide employees to appropriate healthcare facilities and providers. Many healthcare navigation tools also offer additional triaging resources that plug into the benefits plan, such as embedded low or no-cost 24/7 telemedicine visits, pharmacy savings tools, second opinion services, and cost and quality of care directories. When combined with a wellness and/or employee engagement strategy, many employers report a shift in employee healthcare consumerism.

Next Steps for Plan Sponsors

A holistic approach to healthcare navigation includes education around all facets of employee healthcare, include primary care, telemedicine, mental and physical wellness, and site of care optimization. As plan sponsors prepare for annual health plan renewal, many spend time digging into claims experience reports for data points such as ER visit volume, urgent care utilization, and out-of-network spend. Reach out to your AssuredPartners team to review your health plan data and discuss opportunities for employee engagement around healthcare utilization and navigation.

Need more insights? Your local AssuredPartners team can help.

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