In a study of 18 urban hospitals, 3.1 percent of Emergency Department (ED) users account for 16.5 percent of visits. Spectrum Health’s EDs at their two largest hospitals located in Grand Rapids Michigan treat about 1,000 patients visiting the ED at least ten times a year. Very often these patients are coming for non-urgent needs that the ED is unable to address.
Spectrum Health is a regional, not-for-profit health system with eleven hospitals treating a vulnerable population. The system has 2,000 licensed beds, a multispecialty medical group with 423 providers, and an in-house health plan known as Priority Health with 6,34,000 enrollees .
In 2008, Dr. R. Corey Waller an emergency medicine and addiction specialist at Spectrum, was concerned with the frequent use of EDs and the growing number of patients coming to the ED with a wide array of medical, mental, and substance abuse problems. By doing a pilot study and devoting one day a week to caring for 30 heavy ED users, he was able to reduce ED visits by 85 percent.
He then shared his data with health system leaders and asked for support and funding for a more systematic program to serve high ED users which led to the opening of the “Center for Integrative Medicine at Spectrum Health.”
The first step for the program was to identify and enroll frequent ED users by searching Spectrum’s EMRs to identify 100 patients visiting the ED more than ten times a year. The staff invited these patients to participate in a program with 94 agreeing to do so.
Today, on an ongoing basis, the program receives referrals from physicians at area EDs with the program staff reviewing the EMRs to evaluate referred patients on their past use of the health system and the likelihood for future use.
Spectrum’s Center for Integrative Medicine is now able to provide, manage, and coordinate intensive concurrent medical and behavioral healthcare patients and provide addiction services and social services for frequent ED users.
This is accomplished by having the patients undergo a four hour intake visit at the Center where a physician evaluates the patient and where a licensed master social worker provides a behavioral health evaluation that includes assessing substance use and addiction issues.
Patients also receive ongoing assessment and management through frequent clinic visits, round-the-clock access to providers, linkages to needed social services, and eventual transition to a primary care medical home once the patient is stabilized.
The Center’s program now serves about 400 to 500 patients at any given time and enrolls roughly 400 new patients a year. As of March 2013, the program had identified about 2,100 high ED users in the service area with one million people.
Source: AHRQ Health Care Innovations Exchange at www.innovations.ahrq.gov. The title for the innovation profile is “Coordinated, Intensive Medical, Social, and Behavioral Health Services to Improve Outcomes and Reduce Utilization for Frequent Emergency Department Users.”