Reduction of Hospitalizations and Utilization of Emergent Care

Background:

Vigilant Health began working with a Mississippi municipality in 2017. After Vigilant Health’s first phase of its proprietary evaluation process of medical claims data, a plan of care for the health plan was presented to the city council. It was evident upon initial review of the data that two significant areas of rising plan costs were attributable to high ER utilization and hospitalizations, especially among chronic disease patients.

 

Action:

Opening access to acute care was the first step in reducing the use of emergent care. Vigilant Health opened its near site Clinic staffed by a Community Physician, Nurse Practitioner, Nurse Practitioner Navigator, and LPN. Employees and dependents were given a $0 copay.

Deeper analysis through Vigilant Health’s data analytics software revealed structural issues in the client’s health plan design that contributed to overutilization. Vigilant addressed these structural concerns and also employed its integrated navigation software to unify claims and Clinic data, which identified and stratified the individuals and issues that were driving overutilization. Each individual was then given personalized plans of care. In addition, the Clinic’s Nurse Practitioner Navigator proactively reached out to each individual and as such, educated them on more appropriate methods of obtaining healthcare and the variety of services available at the Clinic at a $0 copay.

 

Results:

  • Over 2017, hospitalizations have decreased by 31% for the plan (34% in chronic disease patients resulting in a cost per case reduction of 41%).
  • Payments by the plan for hospitalizations decreased by $546,180.
  • The decrease in hospitalizations for the plan was driven by Clinic Users, who experienced a 47% reduction. Hospitalization rates were more than twice as high among Non-Clinic Users (identifying a target for next year!).
  • A significant reduction in ER visits occurred among Clinic Users, while a significant increase in ER visits increased among Non-Clinic Users.