Site of Care Optimization: How Employers Can Help Employees Get the Right Care at the Right Cost

Use Primary Care Instead of Urgent Care or the Emergency Room When Appropriate

The emergency room is an essential resource for emergency medical attention. But it isn’t the best place for non-emergent healthcare needs.

Similarly, urgent care can be useful when an issue needs prompt attention but doesn’t require emergency services. However, it shouldn’t replace an ongoing relationship with a primary care provider.

For many routine or non-emergency healthcare needs, primary care should be the first stop.

Primary care providers can help employees:

• Receive preventive care
• Manage ongoing health conditions
• Address new, non-emergent health concerns
• Coordinate care with specialists
• Avoid unnecessary emergency room visits
• Build a long-term relationship with a healthcare provider

A strong primary care relationship can also help employees navigate the healthcare system more effectively. Instead of going directly to an urgent care center or emergency department, employees have a healthcare professional who understands their medical history and can help determine what care they need.

Employers can support right site of care utilization through benefit design, employee education, and care navigation tools.

The objective isn’t to discourage employees from seeking care. It’s to make sure they know where to go based on the urgency and complexity of their healthcare needs.

Choose Independent Providers and Lower-Cost Sites of Care

Hospitals aren’t the only place employees can receive many healthcare services.

For services such as imaging, infusion therapy, independent providers and alternative sites of care can offer great quality services at a lower cost.

For example, an MRI performed at a hospital outpatient department may cost substantially more than an MRI performed at an independent imaging center. Similarly, some infusion services can be safely delivered in independent infusion centers rather than hospital-based settings.

Consider Ambulatory Surgery Centers

For appropriate outpatient procedures, ambulatory surgery centers (ASCs) can provide an alternative to hospital outpatient departments.

ASCs are designed specifically for outpatient surgical care and can often provide certain procedures at a lower cost than hospital-based settings.

However, not every patient or procedure is appropriate for an independent provider or ASC. The right site of care approach depends on the patient’s medical needs, the procedure being performed, and the provider’s recommendation.

The goal is to make sure employees know they have choices.

Compare Costs Before Scheduling Care

Some healthcare services are “shoppable,” meaning they are predictable and can be scheduled in advance.

Shoppable services include:

• Imaging
• Colonoscopies
• Certain outpatient procedures
• Laboratory services
• Infusion services
• Elective surgeries (like knee and hip replacements)

When care can be scheduled, employees have an opportunity to compare providers and prices before receiving the service.

That can make a meaningful difference.

The Alliance’s Smarter Care Advisor^SM and Find a Doctor tools can help employees compare options based on network status and available benefit plan and cost information.

Instead of accepting the first provider recommendation or going to the facility they have always used, employees can take a moment to ask:

• Is this provider in network?
• What will this service cost?
• Are there lower-cost options nearby?
• Is there a Preferred-Value Provider available?
• Does my benefit plan provide an incentive to choose a particular provider?

Use Preferred-Value Providers and Your Benefit Plan

Employers can make right-site-of-care decisions easier by incorporating them into their benefit plan design.

For example, employers may offer no-cost or low-cost care when employees choose designated Preferred-Value Providers. When employees can receive appropriate care with little or no out-of-pocket cost, the benefit plan creates a financial incentive to consider value when making healthcare decisions.

This is an important distinction because it is more successful to give employees a reason to consider choosing high-value healthcare options than it is telling them where to go.