Emergency Department Visits per 1000
Line of business: BlueAlliance Care+ (Medicaid Expansion)
Measure Description
The number of emergency department visits that occur within the attributed members, measured on a per 1,000-member basis and adjusted by risk score.
Notes
- The risk adjusted rate is reported as an observed count of ED visits per 1,000 health plan members.
- The Risk Score is calculated on the group’s health characteristics, such as medical conditions, demographics, and healthcare utilization patterns. This score is calculated using the Johns Hopkins Adjusted Clinical Group® (ACG®) methodology, which analyzes clinical and demographic data to predict future healthcare needs and costs.
- Denominator: sum of medical member months for the performance period.
Best Practices
- Encourage patients to engage with their PCP for annual wellness visits, screenings, and care coordination.
- Engage with patients who are diagnosed with chronic conditions to help prevent and minimize exacerbations and complications.
- Educate patients about appropriate ED use and other options available such as same-day appointments, urgent care, nurse lines, and telehealth.
- Consider extended clinic and telehealth hours and addition of a nurse line.
- Offer/coordinate support services for patients diagnosed with chronic conditions or experiencing exacerbations.
- Consider a scheduled outreach with patients who frequent the ED.
- Triage patients at the registration desk and direct to urgent care if appropriate.
- Keep same-day appointments available.
Exclusions
- Members enrolled for less than seven (7) months in Medicaid Expansion.
- Members who are not actively enrolled in Medicaid Expansion at the end of the performance period.
Coding Disclaimer
The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.
Questions
Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.
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Updated 7/16/2025
