4.Offer Pre-Hospital Diversions
While the study only includes two papers on pre-hospital diversions, Pine says there is one strategy in particular that may be promising: allowing paramedical professionals to determine if a patient who has called an ambulance needs to go to the ED or to another site of care. "Paramedics are not used to their greatest degree," he says.
One way to improve the value of medical care in general is to allow providers to operate at the top of their license," Pines says. "However, it's important to note that if the paramedic determines it is not necessary for the patient to be seen in the ED, there has to be an alternative for that patient who has called the ambulance because they want medical care."
Pines acknowledges that hospitals and paramedics may be resistant to this intervention due to possible legal concerns.
5.Break Down Financial Barriers
The study indicates that higher insurance co-pays reduce ED usage, Pines says, adding that this tactic could create care access issues for many patients. "If you start creating barriers to care, which is where a lot of financial incentives come in with higher co-pays for people and introducing capitation and new payment models like ACOs—where providers will not have an incentive to do more—it's important to look at the other side," he says.
"Does it create patient safety problems? Are certain patients not getting needed care because there is a barrier in place? The problem when you start raising co-pays is that Bill Gates will still get medical care regardless of cost, but people who are much more vulnerable may not have access."