Reducing Avoidable Hospital and ER Visits
Unnecessary emergency room visits and hospital admissions are costly, stressful for patients, and often preventable with the right outpatient care in place. MCM ACO’s Hospital & ER Utilization Management program focuses on identifying why these avoidable visits happen, and building systems to prevent them before they occur.
Our team closely monitors utilization patterns across our patient population, flagging patients who are frequent ER users or at high risk for hospitalization. Often, these patterns point to underlying gaps: a chronic condition that isn’t well controlled, a lack of access to timely primary care, confusion about medications, or a missed follow-up appointment after a previous hospital visit.
Rather than waiting for a crisis, we work proactively with primary care providers to address these gaps directly. This might mean same-day or next-day appointment availability for patients with worsening symptoms, more frequent check-ins for high-risk patients, or better patient education about when to call their doctor versus when to go to the ER.
We also help ensure patients understand appropriate care settings — encouraging use of urgent care or primary care for non-emergency issues, which are often faster, less expensive, and more appropriate than an emergency department visit.
By addressing the root causes of avoidable hospital and ER use, our program helps patients get the right care, in the right setting, at the right time, improving their experience while reducing strain on the broader healthcare system.