Page 52 - Bird RFP Response_Burnham Benefits

Avoidable Care Continuum
Population: Book of Business

This report tracks Potentially Avoidable Emergency Room diagnoses across the spectrum of care settings and offers average treatment cost
comparisons. A potentially avoidable ER visit is defined as a visit for a condition which could have been appropriately managed in another
more cost-effective setting such as an urgent care facility, a primary care provider office, or clinic. The Potential Savings value is calculated
by proportionally reallocating the Avoidable ER Visits for each diagnosis to other care settings and subtracting the total less ER from the
experienced total.

Top Avoidable ER Diagnoses by Potential Savings
$120k

82 Potential Savings
$100k ER Visits

$80k

47
$60k 45
39
34 33
$40k 31

$20k 15 16

4
$0k
Headache Strains / Urinary Tract Back Pain Acute Upper Constipation Acute Acute Throat Otitis Media Allergies
Sprains Infection Respiratory Bronchitis Infection
Infection

• The top diagnosis, Headache, had $97,252 of potential savings in the Jan-18 to Dec-18 period.
• These Headache savings account for 20% of the total potential savings in the period.
• Strains / Sprains was the diagnosis which led to the most avoidable ER visits (82).
Reporting Period
Avoidable ER Urgent Care Office Total Potential
Jan-18 to Dec-18
Visits Paid / Visit Visits Paid / Visit Visits Paid / Visit Visits Paid / Visit Savings
Acute Bronchitis 31 $1,222 79 $114 280 $71 390 $172 $35,380
Acute Throat Infection 39 $886 98 $107 600 $77 737 $124 $31,378
Acute Upper Respiratory Infection 45 $1,163 168 $110 1,009 $65 1,222 $112 $49,093
Allergies 4 $1,022 10 $103 257 $96 271 $110 $3,705
Back Pain 33 $1,668 8 $59 551 $104 592 $191 $51,640
Conjunctivitis 5 $725 24 $87 126 $58 155 $84 $3,310
Constipation 15 $2,615 2 $53 75 $100 92 $509 $37,746
General Exam/Preventive Care 4 $921 11 $80 1,774 $149 1,789 $151 $3,089
Headache 47 $2,175 9 $112 123 $105 179 $649 $97,252
Otitis Media 16 $1,256 50 $74 404 $70 470 $111 $18,971
Prescription Refill 0 $0 2 $155 4 $19 6 $64 $0
Rash/Dermatitis/Insect Bites 8 $480 27 $98 283 $66 318 $79 $3,290
Strains/Sprains 82 $1,236 39 $114 261 $103 382 $347 $92,775
Urinary Tract Infection 34 $2,083 46 $121 190 $77 270 $337 $67,917
Total 363 $1,457 573 $105 5,937 $100 6,873 $172 $492,188

Reporting Period: Paid January 2018 to December 2018
Comparison Period: Paid January 2017 to December 2017
Benchmark: Commercial February 15, 2019
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