ED Care Coordination

SB 1561 has passed through both the House and Senate and now awaits the Governor’s signature. I am excited because this legislation exemplifies how innovation and private sector enterprise can be applied to state-administered health care, which in turn improves healthcare quality and lowers costs. Emergency Department (ED) Care Coordination helps reduce duplicated imaging services, narcotic prescribing, and testing. Most importantly, ED Care Coordination flags patients who use emergency services for all their medical needs, often referred to as “Super Utilizers,” and connects them to primary care. Patient “medical homes”  have been shown to significantly improve outcomes.

When you see a doctor regularly not only do they know your medical history, but they build a relationship with you so that together you can best align goals and interventions to better your overall health. Emergency room process and design was never set up to provide continuity of care or to manage chronic disease, pain, or even short-term acute illnesses .

With ED Care Coordination, there is a data system in place making it possible for primary care doctors and all emergency rooms across the state to share information for clinical care, all while keeping that patient information confidential and protected. This interconnectivity makes sure the patient’s history is complete and helps a provider see the big picture so that the treatment that day is relevant and in keeping with the long term plan of care.

For example, take a patient who is seen at one ED location and receives an abdominal CT scan and pain medication. If this patient goes to another ED, the doctor is able to see the results of the CT scan, thus preventing an order for another scan unnecessary. The doctor can also check the Prescription Monitoring Program, which will identify an individual who has recently filled prescriptions from multiple providers, a common way to get lots of pills for sale and abuse. ED doctors can connect patients to their existing primary care physician or find them one. Case managers, who are often nurses, serve as the coordinators of this process. They get the patient information and make the connections to ensure that the patients are able to get needed appointments and actually get to that appointment and a medical home.

This process has been proven effective at reducing the number of repeat ED visits, lowering the overall cost of healthcare and has helped get people struggling with opiate addiction access to detox and other services before they become a victim of overdose.  When ED Care Coordination was first instituted in Washington State, ED visits of the “Super Utilizers” fell by 37 percent, with initial Medicaid savings exceeding $33 million. Similar pilot programs have started in New York, Pennsylvania and Minnesota.

SB 1561 sets up the process by which we institute this in Virginia, while a companion budget amendment provides the seed money necessary to initiate the program. I sponsored this bill in the Senate and Delegate John O’Bannon had the same bill in the House.

In 2017 the program will be initiated for Medicaid recipients, and the following year coverage will be available to all Virginians. ED Care Coordination is the kind of ingenuity and coordination that can make a difference for patients, improve access to care, help to better manage chronic illness, and effectively combat the ongoing opiate crisis. We are going to significantly lower costs and simultaneously increase the number of people leading healthy lives. To me, that’s just good policy.