Bending the Curve: Innovative Health Plan Collaboration to Reduce Unnecessary ED Visits and Inpatient Stays

Tuesday, April 12th

About the Session

The focus of this program is to discuss a model of care that extends the reach of a healthcare system, on-demand and beyond the walls of hospitals, thereby adjusting to changing consumer preferences and achieving value-based goals.

In the Las Vegas market, UnitedHealthcare partnered with in-home acute care provider DispatchHealth to develop a new program addressing high emergency department and inpatient utilization among its commercial and Medicaid members. Named the “Plan Directed Visit Program,” it actively engaged with health plan members who have a history of ED utilization and chronic conditions through a zero out-of-pocket, multichannel approach that delivers whole-person, clinically integrated care to their homes. The program has completed 8,000 home visits since its implementation in April 2019. The value of this partnership proved particularly beneficial at the height of the COVID-19 pandemic. By extending home-based care, the program was able to prevent nearly 3,500 of Las Vegas’s most vulnerable population, who would have fared very poorly if infected with COVID-19, out of the hospital(s) where facility-acquired infection rates were of particular concern. This pool of ED diversions resulted in $3.2 million in cost savings while addressing emergency room congestion and reducing the burden on overwhelmed front-line workers. The program has also increased primary care engagement by 35% as remote caregivers educate members on the importance of developing a PCP relationship while they are in the home.

This model enables payers, providers, health systems, EMS, employer groups, and others to scale acute care services into the home quickly. By offering a home-based, complimentary service line, organizations lessen the burden of unnecessary ED visits, hospital stays, readmissions, skilled nursing facility stays, and maintain a focus on right-size care. ACHE Fellow Dave Dookeeram and Dr. Tibaldi will discuss the program’s genesis, governance, operations, and performance. They will touch on scalability and the financial sustainability of the model, along with the demonstrated achievement of the Quadruple Aim goals of lowering total cost of care while improving outcomes and elevating both the patient and the provider satisfaction.

Learning Objectives:

  • Review, quantify and describe the opportunity to reduce unnecessary ED and inpatient utilization. Describe the care model and infrastructure supporting this innovation.
  • Discuss the validated outcomes over the 24-month program life span, and review the application of home-based acute care models elsewhere in the U.S.


Presented By

Dave Dookeeram, FACHE, FHM

Executive Vice President/Chief of Staff

Laurine Tibaldi, MD, FACP

Chief Medical Officer