The healthcare system is one of the most confusing and difficult-to-navigate industries that exists.   Healthcare makes up the greatest percentage of the US gross domestic product, with over $3 trillion in spending in 2014 (1), yet despite its mammoth impact on all of our lives, many of us don’t know its inner workings and the various options we have as patients to secure the best, most affordable care possible when problems arise. In no place is this more pervasive than in the Emergency Room, where over 50 million people make unnecessary visits each year for non-emergent issues. The result—wasteful spending, wasted time, and further stress on an already weakened healthcare system with every stakeholder losing out:

  • Patients receive less appropriate care, experience longer wait times, and pay more out of pocket.
  • Insurance companies face millions of dollars in losses.
  • Hospitals bear wasted resources, overcrowding, and economic losses.

From 1997-2007 the number of ER visits increased 23% (2), almost twice the expected rate based on population growth. In addition to the alarming increase in ER utilization, it is estimated that  up to 30% of ER visits are unnecessary (3) and could potentially be resolved more quickly and at a lower cost elsewhere. Shifting these unnecessary ER visits to more appropriate sites could save the healthcare system $4.4 billion annually (4).

What is the true effect and cost when a patient goes to the ER for a non-emergent complaint? There’s time—patients wait significantly longer to be seen and receive care. There’s cost—the cost of an ER visit is $580-700 compared to $130-180 at an office based visit or Urgent Care Center (5) (excluding the cost of taking an ambulance, which can be $900 per mile). Finally, there’s waste—wasted resources from ERs devoting costly services and healthcare providers to care for additional patients with non-emergency conditions in over-crowded emergency departments.

As discussed in an earlier piece on Hippo Reads The Anatomy of a Hospital, or Why Your ER Wait Time is So Long, (6) reasons for long wait times include problems from overcrowding, inefficient triage, and lack of consumer awareness. In a survey of the top reasons for going to the ER in a non-emergency, 73% reported “urgency” as the main reason. This is no surprise given that most of what you find on Google, WebMD, and  other websites forces you to self-diagnose your condition. This is virtually impossible for most people, especially those with limited or no medical  background.  The list of potential diagnoses that pop up on these search engines can be overwhelming and scary: cancer, heart attack, stroke, and more. It’s no wonder why people are flocking to the emergency department for immediate life-saving care.

Despite these pitfalls,  solutions are on the rise to help patients find the right care at the right place at the right time.  Healthcare consumerism is booming, and patients are increasingly tech-savvy and actively seeking ways to integrate technology with their healthcare. Telehealth creates a new way to interact from your home with a physician, and other platforms are rolling out to help patients monitor and track their health to prevent exacerbations of chronic diseases that can lead to ER visits or worse outcomes. Hospitals even employ people to help download apps on patients’ phones or smart devices, and teach them how to take ownership of their healthcare.

For  the specific problem of reducing unnecessary ER visits, however, there still isn’t a solution. Self-diagnosis relies too heavily on a person having a medical background and current websites and mobile-based tools do little to  assist in the decision process for patients seeking care. And while Telehealth may give you the chance to speak with a physician it doesn’t allow you to receive a physical exam and receive direct care when needed.

One possible solution is a new web platform and app called am-i-ok. Am-i-ok seeks to take the decision process away from the patient using a proprietary algorithm that is quickly able to source a complaint as emergent or non-emergent based on the patient’s responses. Using “yes/no” questions, it is able to quickly and more appropriately determine the urgency of a complaint. Working with insurance companies, hospital systems, and urgent care centers, am-i-ok aims to ensure the most appropriate care while giving direction to proper care locations for its users (e.g. urgent care centers versus emergency departments). It’s  a simple model that can be thought of as a canary in a coal mine–teering away from self-diagnosis, am-i-ok isn’t focused on “what” a person has, simply is it an urgent or emergent complaint, and where should the patient go.

At the end of 2015 Forbes predicted that patients will trust health apps “more than their doctors” (7) in the coming year. While that trend is certainly growing, creating easy to follow, simple, consumer-driven apps that can assist patients with minimal or no healthcare knowledge may be the solution. In the last five years alone we have seen the growth of ZocDoc, Pager, and DoctorsOnDemand as patients seek the ability to access healthcare anytime, anywhere, any place from the palm of their hand. While nothing can replace the need to see a physician and receive care when care is needed, helping to connect patients to healthcare providers quickly and efficiently is the goal of the future—and the solution may be right at our fingertips.

*For anyone interested in learning about am-i-ok, or for hospital systems, insurance companies, or urgent care centers interested in working with am-i-ok you can contact them here.

Notes

1.Martin AB, Hartman M, Benson J, Catlin A. National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending. Health Affairs. 2015;35(1):1-11.

2. Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R. Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010;304(6):664-670.

3. Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Deciding to visit the emergency department for non-urgent conditions: a systematic review of the literature. American Journal of Managed Care. 2013;19(1):47-59.

4. Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs (Millwood). 2010;29(9):1630-6.

5. Massachusetts Health Policy Commission. 2014 Cost Trends Report. Chapter 5. Wasteful Spending: Readmissions and Emergency Department Use; 2014:1-84.

6. http://read.hipporeads.com/anatomy-of-a-hospital-or-why-your-er-wait-time-is-so-long/

7. http://www.forbes.com/sites/jenniferelias/2015/12/31/in-2016-users-will-trust-health-apps-more-than-their-doctors/

About The Author

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Mark Wien

Mark Wien is the co-founder of the Micro Equity Development Fund, a for-profit, social initiative focused on connecting investors with investment opportunities in microfinance, particularly micro-equity. Mark also co-founded an e-commerce site which launched in March 2014. After six years in finance, Mark is currently in medical school with hopes of bridging his business background with medicine to improve access to and quality of healthcare worldwide. He will be joining Hippo as a frequent correspondent exploring the topics of public health, the intersection of medicine and business, healthcare, and microfinance. Twitter: @MarkWien; Mark.Wien@themedf.com.