Risk Adjusted Utilization: Emergency Department Utilization: Introduction

Healthcare evolves rapidly and with that the need for patients to have access to quality healthcare they have confidence in. There are multiple organizations monitoring this, The National Committee for Quality Assurance (NCQA) being just one. This organization was formed specifically to monitor the care patients were receiving along with measurements of patient outcomes, with these measurements standards of care were set. This paper discusses a performance measure developed by the Healthcare Effectiveness Data and Information Set (HEDIS) and how it measures the performance that providers give as HEDIS is used by millions of health insurance companies to help find areas where healthcare professionals can improve. (NCQA, {2021}) I will also discuss three interventions for patients and how, as a Nurse Practitioner (NP), the outcomes will be measured of the care delivered as well as the cost savings for the practice and the improved ratings along with a conclusion. The Healthcare Effectiveness Data and Information Set has six domains of care where performance in healthcare is measured. The interventions in this paper will be discussed from the domain: Risk Adjusted Utilization, specifically Emergency Department Utilization.

Interventions

In October of 2012, the American College of Emergency Physicians Scientific Assembly said that health care costs in the United States have made many examine the values of services delivered with programs aimed at improving the efficiency of emergency departments.

Emergency departments are available for critically ill patients as well as unknown acute conditions, but many use the department as regular healthcare due to limited access to healthcare or physicians. It was found that the emergency department was being used for non-acute

conditions resulted in higher charges for the patients and the insurance companies because these low acuity conditions and preventable care can be treated cheaper at a clinic or a primary care provider................. Continue