Emergency Department Utilization – Navigating Members to the Appropriate Care Pathways

 


Integra’s Emergency Department Utilization program, one component of Integra’s comprehensive CompleteConnect offering, is also available as a standalone solution. When members with inappropriate ED utilization rates are identified by the client, Integra’s 30-day program can be rapidly implemented to supplement existing efforts and increase the use of appropriate sites of service.

The Integra program rationalizes ED utilization by providing education and advocacy to ensure appropriate use of primary care, urgent care, Nurseline services, maintenance prescriptions, and access to community resources to address Social Determinants of Health (SDOH), especially transportation. Leveraging the client’s ‘chase list’ of members with inappropriate ED utilization, Integra’s Community Coordinators locate and engage over 40% of these members.

Our Community Coordinators serve as a personal guide for members and their caretakers, navigating them to the appropriate services instead of inappropriately relying on the the Emergency Room for non-emergency services.

When working with a member, our Community Coordinators:

  • Visit the member in the home or, if necessary, shelter
  • Ensure member has adequate supply of prescribed medications and understands the medication schedule
  • Establish primary care and other necessary provider relationships on a timely basis
  • Educate member on appropriate use of Urgent Care for non-emergency, after-hour services
  • Provide appointment reminders and arrange transportation if necessary
  • Identify and address other SDOH barriers to appropriate healthcare utilization

During the 30-day program, a member’s Community Coordinator is available 24/7 to answer any questions and provide additional support and coordination as needed. Following the initial period, the Community Coordinator typically transfers the member to the client’s care or case management if necessary.

Contact us about implementing our Emergency Department Utilization program for your members.