Have you ever debated with yourself whether or not to go to the emergency room? Maybe you slipped while cooking dinner and cut yourself with a kitchen knife, or your kid fell off the swing at the park and might have a broken bone. You probably thought, “I bet it’s all backed up and we’ll be waiting hours just to be told it’s not serious and will heal on its own.” You may have considered the out-of-pocket cost, which can often be north of $500 for an ER visit. You probably didn’t think, “I wonder how much this will cost my employer.”
HR and Benefits leaders are all too familiar with this debate, and they definitely think about the costs of ER visits for self-insured employers. Companies that self-insure are taking on the full cost of health coverage for employees, so benefits teams are tasked with monitoring and managing costs. They think about ER visits, diabetes medications, cancer treatment, hypertension, and many other high-cost claims.
Benefits leaders look at their healthcare data to find out what ER visits are costing them, along with other “places of service” for healthcare. Artemis Health is here to help, with all the tools benefits teams need to dive into their claims and find opportunities for more efficient benefits spending. Let’s look at an example where we compared the place of service to find trends and insights using sample data.
This chart from the Artemis Platform shows a comparison of the employer amount paid for medical claims at four different places of service: the emergency room, a primary care provider, urgent care centers, or telemedicine visits. Emergency room spending is clearly the highest, and there are many good reasons for this. Obviously, a life-saving intervention for a serious car accident will cost more than a telemedicine visit for a urinary tract infection.
Let’s look at more data for these places of service.
Now we’ve calculated the sheer number of visits to each place of service. For this sample data, member visits to their primary care physicians far outnumber visits to any other type of care, whether it’s urgent care, the ER, or a telemedicine call. While urgent care and the ER are neck and neck with visits under 1,000 each month, there is one interesting data insight here: telemedicine is seeing an uptick.
The sample data shown is starting in Feb. 2020, where you can see a clear rise in the number of telemedicine visits. Many Artemis customers have noted this trend in their population data too, which is a result of increased awareness of telemedicine as an option for people due to the COVID-19 pandemic. Benefits teams may look at this data and come up with a plan to promote, educate employees, and further boost utilization of their telemedicine benefits.
The Artemis Platform allows us to dive deeper into each place of service and find out which conditions are being treated by which type of facility.
In this table, the top diagnosis group is for “symptoms, signs, and ill-defined conditions,” which essentially means, “We don’t know.” This presents an opportunity for employers to provide member education on how to handle initial diagnoses, including visiting an PCP, specialist, or through second-opinion services. Additionally, the sample data shows a number of conditions that could be treated at urgent care instead of the ER, like UTIs, fractures, and superficial injuries.
Finally, let’s take a look at which conditions are commonly being treated with telemedicine visits.
The top five conditions for employer costs are all behavioral health conditions, including mood disorders, anxiety disorders, adjustment disorders, and attention deficit disorders. This trend for telemedicine could help an employer justify a new mental health program or carved-out behavioral health care management vendor with telemedicine options for members.
We hope this helps you understand the role data plays in finding trends and comparing place of service in your employee benefits. Artemis helps employers and their advisors explore this topic and many other benefits questions with our cutting-edge tools and service.