Poon SJ, et al. - Researchers conducted this cohort study of data from a large commercial health plan from 2008 to 2015 to identify trends in visits to different acute care venues, including urgent care centers, retail clinics, telemedicine, and emergency departments (EDs), with a focus on visits for treatment of low-acuity conditions. Findings showed an increase in total acute care utilization for the treatment of low-acuity conditions and associated spending per member, and a rapid increase in utilization of non-ED acute care venues. These results suggest that patients are more likely to visit urgent care centers versus EDs for the treatment of low-acuity conditions.

Methods

• This cohort study used deidentified health plan claims data from Aetna from January 1, 2008, to December 31, 2015, with ~20 million insured members per study year.
• Researchers performed a descriptive analysis for health plan members <65 years of age.
• Data analysis was also conducted from December 28, 2016, to February 20, 2018.
• Main outcomes and measures included utilization, inflation-adjusted price, and spending associated with visits for the treatment of low-acuity conditions.
• Using diagnosis codes, researchers identified low-acuity conditions that included acute respiratory infections, urinary tract infections, rashes, and musculoskeletal strains.

Results

• A total of 20.6 million acute care visits for the treatment of low-acuity conditions were included in the study.
• There was a 36% decrease in visits to the ED for the treatment of low-acuity conditions (from 89 visits per 1,000 members in 2008 to 57 visits per 1,000 members in 2015) versus a 140% increase in the use of non-ED venues (from 54 visits per 1,000 members in 2008 to 131 visits per 1,000 members in 2015).
• Visits to all non-ED venues increased: urgent care centers (119% increase from 47 visits per 1000 members in 2008 to 103 visits per 1,000 members in 2015), retail clinics (214% increase from 7 visits per 1,000 members in 2008 to 22 visits per 1,000 members in 2015), and telemedicine (from 0 visits in 2008 to 6 visits per 1,000 members in 2015).
• For low-acuity conditions, utilization increased by 31% (from 143 visits per 1,000 members in 2008 to 188 visits per 1,000 members in 2015), and spending per person per year increased by 14% ($70 per member in 2008 to $80 per member in 2015).
• The primary driver of the increase in spending was a 79% increase in price per ED visit for treatment of low-acuity conditions (from $914 per visit in 2008 to $1637 per visit in 2015).