OBJECTIVES: The overuse of emergency departments (EDs) in the United States is responsible for considerable and unnecessary healthcare spending each year. The objective of this study was to evaluate the effectiveness of the ED management component, which provides nurse-based phone intervention, as part of BCBSLA’s case management and disease management (CM/DM) initiatives.

METHODS: BCBSLA members with continuous enrollment from January 1, 2012 through December 31, 2015 participating in any one of the CM/DM initiatives were eligible for study inclusion. During the calendar year 2013, case managers affiliated with the CM/DM programs attempted to make contact with members up to 45 days after an ambulatory ED visit. Members that were successfully contacted and participated in the ED management program were included in the intervention group and members that had ED visits, but were not participating in CM/DM program became the control group. The intervention cohort was then propensity matched based on a series of characteristics using the 2012 calendar year as the baseline period. A difference in difference (DID) regression model estimated the effect of the ED management program on the number of ED ambulatory visits and per member per month (PMPM) expenditures.

RESULTS: Case managers attempted to contact 6,596 members (4% of ED visitors) from January 1, 2013 through December 31, 2013 via any of the CM/DM programs. Final sample size after all inclusion and exclusion criteria were met and cohorts were 1:1 propensity matched was 4,728, with 2,364 members in each group. DID results at the end of the follow-up period showed a downward trend in ED ambulatory visits with estimated overall cost savings of $55 PMPM.

CONCLUSIONS:The overuse of EDs in the United States is a costly problem, but effective ED management programs can result in significant PMPM savings.