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Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) |
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Emergency Department Utilization Initiative
Goal · Reduce the emergency department use for primary care sensitive conditions; and · Reduce the percent of PGIP-attributed patients who are frequent (5 or more visits per year) ED users for primary care sensitive conditions.
Objective · Reduce JPA’s ED use compared to the PGIP average. Decrease the number frequent ED users (defined as 5 or more visits per year) compared to the PGIP average. JPA’s Risk Adjusted ED Standard Cost PMPM for Adults in 2009 was $6.95. The Benchmark performance (10% of Population) range was $5.04 to $5.58.
Practices should 1. Expand outpatient office hours, same day appointments; 2. Educate patients on what to do, re: after hours care; 3. Send letters to patients who are consistently utilizing ED services inappropriately; and 4. Contact Allegiance ER Case Managers to assist in educating frequent fliers on appropriate utilization for ED.
Resources · ED Tool Kit * Common Non-Emergency and Emergency
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Service Focused Initiative |