Leveraging Real-Time Data to Reduce Unnecessary ED Utilization

An increasingly lesser known fact about me is that I started my career as a Physical Therapist treating orthopedic patients. There is a phenomenon known as the “pain cycle” that we regularly tried to break. In that cycle, an initial trauma causes pain, pain causes muscle spasm, muscle spasm reduces blood flow and reduced blood flow causes more pain. As you can imagine, that becomes perpetual until at least one of the elements is removed—thereby breaking the cycle. 

At a macro level, there are so many cycles we try to break across the industry in pursuit of improved outcomes and lower costs. Leveraging real-time notification technology, our partners at CareOregon have done just that. In this case, they identified their Medicaid population was accessing the emergency department (ED) for dental problems at a disproportionate rate. The ED is set up to treat the symptom, but not the root cause and because the root cause is not resolved the member ends up back in the ED—a self-perpetuating cycle that leads to poor outcomes and drives up costs.