Project 2.b.iii – Emergency Department (ED) care triage for at-risk populations

Why FLPPS Chose this Project

In the Finger Lakes region, a driver of avoidable hospital use includes use of the ED for treatment of conditions which could have been potentially treated in a more effective and lower cost setting, such as a primary care office or an urgent care center.  The FLPPS region has a higher rate of Potentially Preventable Visits (PPV) as compared to the rest of NYS.

Nearly 39% of ED visits for Medicaid patients are Potentially Preventable Visits

Emergency rooms are often used by patients to receive non-urgent services for many reasons including convenience, lack of primary care physician, perceived lack of availability of primary care physician (PCP), perception of rapid care, perception of higher quality care and familiarity. Emergency departments represents another form of hospital-based care that is a key contributor to health care cost and resource utilization.

A gap in access to primary care has led to significant over-utilization of the ED. Inappropriate use of the ED is also due to a gap in services caused by transportation barriers and inadequate PCP capacity.

Seven counties in the FLPPS region are fully designated by HRSA as Primary Care Health Provider Shortage Areas, as well as and portions of the additional 5 counties.

What Success Looks Like

Providing the support needed to link patients to a primary care physician or practitioner, while supporting patient understanding and confidence to manage their personal health conditions.

Through education and the removal of barriers to access, patients can more effectively engage with their primary care provider and become better equipped to manage their own health.

Success will also include improved provider to provider communication and provide supportive assistance to transitioning members.