Low Acuity Non-Emergency ED Visits on the Rise

In recent months we have noticed an increase in the number of members with low acuity, non-emergent conditions visiting the emergency department.

In February 2021 alone, 2,157 of our members had 2,410 ED visits for non-emergent conditions. We are finding that members are being advised to return to the emergency department multiple times for follow up after the initial visit rather than being referred for follow up with their primary care physician. They are also being asked to wait a certain number of days after being seen in the emergency department before they can be seen in their primary care physician’s office.

As a result, we have recently reminded Optima Health members to:

      • Call a nurse for FREE, 24/7 to find out what kind of doctor to see. The number for the Nurse Advise Line can be found on the back of the members ID card.
      • Contact their PCP first when starting to feel sick with symptoms such as sore throat, fever, or when they have questions about their medications, to name just a few. Review the graphic below for our complete guidance to our members on seeking care based on severity.
      • Visit the nearest Urgent Care Center or take advantage of telehealth platforms when seeking care outside normal office hours or after visiting the emergency room.
      • Remain in touch with their primary care physician when they receive care from other providers.

Where should members go for the care they need?

If members are sick, it is important to know where to they should go to get the best care they need. The severity of their condition, wait times and costs all factor in.

The information below can help members determine their best care options.

  Routine Health Issues — Call Your Doctor

You should see your doctor for routine health issues.

Once you get to your appointment, your wait time should be short. Costs tend to be lowest here.

  • refill and renew medications
  • chronic illness
  • vaccines
  • long term urine/bowel issues
  • most behavioral health needs
  • flu, sore throat, fever
  • tooth ache
  • any symptoms listed under urgent care

  Immediate Health Care Needs

Schedule Virtual Visits with MDLIVE

MDLIVE is your on–demand access to affordable, quality health care any time, any where.

With MDLIVE you can speak with a board-certified doctor or licensed therapist at anytime, from anywhere, by video conference or phone.

Access MDLIVE (sign in required) to schedule a virtual visit

You can also call (866) 648-3638 (TTY 1-800-770-5531)

Access Urgent Care

Optima Health members have access to urgent care centers such as First Med and Patient First.

Most of the following can likely be handled by your primary care physician (PCP), but based on when you can get an appointment, Urgent Care may be a better option.

  • cough/cold/runny nose
  • throat pain or sore throat
  • ear pain
  • pain/burning in urine
  • headache
  • nausea/vomiting
  • loose stools/diarrhea
  • fever less than 104°F
  • rash
  • back pain
  • penile/vaginal discharge
  • minor injuries, cuts, burns

  Emergency Care — Go to the ER or Call 911

In emergency situations such as those listed below, you should go to the ER or call 911 immediately.

The ER will give priority to the most urgent health conditions. Those with less serious conditions may face longer wait times. Costs tend to be highest here.

  • chest pain
  • head trauma
  • trouble breathing
  • broken bones
  • poisoning
  • seizures
  • severe bleeding
  • loss of vision
  • stroke
  • fever over 104°F
  • vaginal bleeding when pregnant
  • plans to harm yourself

We understand that the pandemic has created a heightened sense of awareness and concern for everyone’s safety. To that end, please partner with us by providing the above guidance to our shared customers to ensure they receive the care they need, when they need it.