Selecting the Appropriate Level of Care Can Help Control Healthcare Costs

Sometimes employees make poor decisions when it comes to selecting the appropriate level of care for their medical needs. The result can be higher than average claims which in turn, increase overall plan utilization, and ultimately raise premiums (or premium equivalent rates for self-funded groups). For schools, cities and counties that are self-funded, this is a prime concern. Addressing this issue head-on can assist in controlling these costs.

So why do employees choose to visit urgent care/emergency room (ER) to address their minor, non-urgent conditions? According to the National Health Interview Survey (2013-2014), 12% of adults aged 18-64 visited the ER because their doctor’s office was not open (after hours). And 7% visited because they did not have access to another provider (lack of a primary care doctor).¹ Others may also elect this option if they can’t get a same day appointment with their doctor, instead of waiting until the next day.

Another ‘pricey’ route that some employees use is to see a specialist without a referral. Often times, a quick visit to his/her primary care doctor would have sufficed.

What can you do?

It is important that employers educate employees about making cost effective and smart decisions when it comes to choosing appropriate care. Communicate often and in a variety of ways including posters, paycheck stuffers, benefit meetings, emails, flyers, newsletters, videos, etc. Choose regular reminder intervals such as monthly or quarterly.

Make sure they know their options, what co-pays may be involved, the costs covered/not-covered, time involved, etc. Helping employees to choose the appropriate place of care not only reduces costs, but also ensures the most appropriate medical care for the particular condition.

Additionally, school, city and county employers can also make primary care part of their healthcare strategy by:

• Creating a benefit design that encourages primary care access such as low co-pays and/or deductibles are impacted
• Making sure your selected network has adequate primary care coverage (same-day appointment and after hour availability)
• Implementing an on-site or near-site clinic (easy employee primary care access)

For questions, contact your NIS Representative.

1Gindi RM, Black LI, Cohen RA. Reasons for emergency room use among U.S. adults aged 18–64: National Health Interview Survey, 2013 and 2014. National health statistics reports; no 90. Hyattsville, MD: National Center for Health Statistics. 2016.