How acute care intervention steps in for patients who need it most

No care provider or health plan wants patients to end up in the emergency room (ER). These are expensive uses of healthcare resources, and a hospital stay is often stressful for patients and their families.

Acute care intervention focuses on keeping patients out of the ER by preventing or mitigating their urgent care needs.

What is acute care intervention?

Under traditional models of care, acute care interventions refer to treatments or therapies that occur in an inpatient setting. This care happens during a hospital stay after surgery or after a patient has been admitted to the hospital from the ER. It's care that can help stabilize the patient until they are well enough to continue treatment and recovery at home.

For Carelon Health, acute care intervention also extends well beyond the inpatient setting into the outpatient world, says Dr. Johana Rodriguez, Medical Officer at Carelon Health. "When a patient experiences changes in their clinical status that require prompt evaluation and management, their care team must be equipped to not only diagnose but also intervene, and that's the key to making a difference," she says.

For example, let’s look at a patient with heart failure, a condition that affects more than 6 million adults in the United States.

When a doctor first meets this patient, their heart failure is borderline. Their symptoms, which are barely noticeable, are under control. Over time, even with treatment, the patient's heart failure may get worse. They can start to experience some scary symptoms, such as extreme fatigue, weight gain, and shortness of breath.

"Under a traditional, fragmented model of care, most provider offices won't be able to provide the acute intervention this patient needs," says Dr. Rodriguez. Without acute intervention, such as intravenous medicines to stabilize fluid retention, this heart failure patient could end up in the ER.

There's a solution, however. A team that provides acute care intervention can safely initiate the needed treatment in an outpatient setting, says Dr. Rodriguez. "Acute care intervention is fundamental to Carelon Health's model of care. When a patient is experiencing an acute disease process, our goal is to be able to care for the member when they need us the most, whether at our care centers or in their home," she says.

Tackling a growing problem in healthcare

Avoidable use of emergency rooms is a growing and expensive problem in the United States. Total ER spending grew to nearly $137 billion in 2016, according to a 2021 PLoS One analysis. While spending for ER care only represents a portion of overall healthcare spending in the U.S., a 2022 study published in the American Journal of Emergency Medicine noted that "spending on ED [emergency department] services in recent years has increased faster than spending in any other area of healthcare." From 2012 to 2019, ER treatment costs increased from $54 billion to $88 billion, a 5.4% annual growth rate with 4.4 percentage points attributed to higher treatment cost per visit, the study found.

Before the COVID-19 pandemic, traffic injuries, falls, and urinary diseases were the top three reasons people landed in the ER. They accounted for more than 14% of all ER healthcare spending, according to the PLoS One study.

Healthcare providers obviously can't stop traffic accidents directly. They can play a role indirectly, though. For example, they can help patients avoid drowsy driving related to pain medicine or sleep disorders, such as sleep apnea. They can also directly help patients manage medical conditions that can lead to falls and urinary issues.

Most patients who go to the emergency room do not get admitted to the hospital. They are treated in the ER and sent home. For complex medical patients, like those cared for through Carelon Health, that means there's a chance to prevent ER use through acute care intervention.

Fitting into Carelon Health's Advanced Primary Care model

Advanced care intervention has long been a focus of Carelon Health. "It's in our DNA," says Dr. Rodriguez. "We care for very frail, high-risk patient populations. We need to be able to care for our members wherever they are in the severity spectrum for their disease processes."

Through our hospital-at-home program, care team members provide care for acute care issues in a patient's home setting. These issues could otherwise lead to ER use and even hospitalization. "We all take ownership and pride in the care we render. We have excellent success with our hospital-at-home program," says Dr. Rodriguez.

Patients enrolled in Carelon Health's Advanced Primary Care model receive whole-health and patient-centered care. This includes care coordination, acute care intervention, and robust preventive care designed to address and prevent:

  • Complications from chronic medical conditions and their treatment.
  • Disease progression and worsening symptoms.
  • Seasonal and other standalone health issues, such as the flu, pneumonia, and COVID-19.
  • Emotional health issues related to their medical condition and treatment.

Interdisciplinary collaborations are a key part of Carelon's Advanced Primary Care model. The common goal is complete patient care.  "Our care teams work together to provide targeted care to our patients," says Dr. Rodriguez. "We leverage different care teams' expertise to improve our management."

Carelon Health's robust preventive care is part of its risk factor optimization, adds Dr. Rodriguez, with a focus on evidence-based preventive care designed to keep patients healthy.

"It reduces the risk of an acute disease process progressing into a severe acute state," says Dr. Rodriguez. "For example, a viral upper respiratory infection in a patient who suffers from chronic obstructive pulmonary disease could trigger an acute exacerbation episode. We have vaccines that can help us reduce that risk."

Why health plans should insist on acute care intervention

With Carelon Health's Advanced Primary Care, acute care intervention is built in. Our care teams are well versed in addressing the physical, emotional, social, and financial care needs of patients. "That means we not only have providers comfortable with high-acuity cases, but they also have the needed tools readily available to provide advanced care," says Dr. Rodriguez. "The core care team anticipates what the patient's needs will be every step of the way and develops a plan that addresses the patient's challenges."

Treating complex medical patients requires a commitment to providing care that addresses and prevents acute care needs. Fragmented care models that ignore patients' acute care needs could result in less satisfied patients, worse healthcare outcomes, and higher healthcare costs.

Carelon Health's acute care intervention and coordinated care save patients and caregivers the stress of an ER or hospital visit. This, in turn, saves health plans the financial stress associated with ER and inpatient care. Health plans focused on delivering quality, whole-health care should look for acute care intervention as a baseline service when supporting patients with complex or chronic conditions.