Poon SJ, et al. - In this cohort study of data from 2008 to 2015 from a large commercial health plan, researchers characterized trends in visits to different acute care venues, including urgent care centers, retail clinics, telemedicine, and emergency departments (EDs), focusing on visits for treatment of low-acuity conditions. Findings revealed an increase in total acute care utilization for the treatment of low-acuity conditions and related spending per member, and a rapid increase in utilization of non-ED acute care venues from 2008 to 2015. For the treatment of low-acuity conditions, patients are more likely to visit urgent care centers than EDs.

Methods

• Researchers used deidentified health plan claims data from Aetna, a large, national, commercial health plan, from January 1, 2008 to December 31, 2015, with approximately 20 million insured members per study year.
• Researchers performed a descriptive analysis for health plan members <65 years of age.
• From December 28, 2016 to February 20, 2018, data analysis was performed.
• Utilization, inflation-adjusted price, and spending associated with visits for treatment of low-acuity conditions were the included main outcomes and measures.
• Using diagnosis codes, they identified low-acuity conditions that included acute respiratory infections, urinary tract infections, rashes, and musculoskeletal strains.

Results

• This investigation included 20.6 million acute care visits for treatment of low-acuity conditions over the 8-year period.
• 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) vs 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 1,000 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).
• For treatment of low-acuity conditions (from $914 per visit in 2008 to $1,637 per visit in 2015), the increase in spending was primarily driven by a 79% increase in price per ED visit.