Andrew Heller is the market research and competitive intelligence manager for Studiomaca Connected Care & Analytics. This is the first post from Andrew who will provide commentary in this and future posts around published industry reports and topics from news story that affect hospitals and health systems.

IMS Health recently released their annual report on medicines and healthcare usage. One notable statistic is the significant decrease in the number of inpatient admissions via the ER experienced in 2013. Conversely, there was a spike in the number of patients who were admitted for a scheduled procedure. Combining these findings with data points taken from The Kaiser Family Foundation 2013 Health Benefits Survey may help illuminate what is occurring.


There are several possible explanations for the decrease in admissions. While it is plausible that patients are becoming more cost conscious and thus seeking out lower cost care settings as a result of higher deductibles, the year-over-year (YoY) data does not demonstrate any statistically significant increase in out-of-pocket (OOP) expenses. Based on the incremental OOP increases shown in the chart below, it seems unlikely that patients have suddenly and dramatically changed their behavior.


Instead, payer networks may be exerting more control over where patients go and how they get treated. As you can see in the chart below, the number of employees covered by plans with narrow networks such as HMOs, PPOs, and HDHP now account for over 90% of all employee coverage in the employer-sponsored market. These networks, at least in theory, grant payers more influence over provider activities.


Additionally, provider networks may be doing a better job of keeping patients healthy – particularly patients with chronic conditions that are most likely to be admitted via the ER. Payer networks may be contributing to this trend by including in their networks physicians that deploy procedures intended to keep their patient populations well– thus avoiding the highest cost care setting, the hospital.

The Medicare readmissions incentive program is also forcing providers to focus on quality. Provider care management activities may have helped decrease readmits, thus contributing to the lower number of patients admitted via the ER.

As shown in the chart below, primary care visits fell, but visits to specialists increased. While we can’t confirm a correlation, it's possible that the increased use of specialists in care delivery models for the chronically ill may have also contributed to the decrease in inpatients admitted via the ER.


Finally, increased medication adherence may have also helped drive the decline in ER admissions, but information regarding medication adherence trends is needed to validate a correlation.

Many of Studiomaca's tools can help providers examine their data to validate patient compliance with care plans and continue to coordinate care between provider networks and pharmacists. This helps our customers continue to decrease the number of patients admitted via the ER which is the most costly care setting.

Note: This post is not to be read as having been conducted with any statistical rigor, only as commentary on published industry reports and topics featured in news stories. The full can be downloaded for free.

Andrew Heller

About the author

Andrew Heller is a Market Intelligence Manager with Studiomaca Connected Care & Analytics. He has been with Studiomaca for over four years. Prior to Studiomaca, Andrew worked in market research roles in health care, technology and consumer electronics companies including Vitera (formerly Sage), Ceridian, Panasonic, and Verizon Wireless (formerly AirTouch). When not at work, Andrew enjoys spending time with his family and the mayhem that comes with raising two boys.