A Qualitative Analysis of Choice-Driving Factors for Emergency Department Utilization Among Medicare Advantage...

Emergency department (ED) utilization among Medicare Advantage patients has been a growing concern. Many patients opt for ED visits, which can lead to overcrowding and increased healthcare costs. Understanding the underlying reasons for this preference is crucial for developing strategies to optimize healthcare delivery and reduce unnecessary ED visits.

The current project aimed to understand the reasons Medicare Advantage patients choose to seek care in the ED setting.

Patients completed interviews to understand drivers behind their choice to seek care in the ED. The responses were analyzed using generative AI to identify themes shaping patient decisions.

Results showed that most ED visits occurred during hours when clinics were open, with injury and trauma-related visits being the most common reasons. The decision to visit the ED was often self-initiated, influenced by friends and family, or guided by healthcare professionals. Many patients used healthcare-related technology, but indicated challenges related to navigating technology. Patients preferred to seek care from their primary care provider (PCP) and specified that their PCP was their first point of contact for nonemergency issues. Patients' decisions on where and when to seek healthcare services were influenced by factors such as preference for a specific health system, insurance coverage, location and accessibility, and experiences with certain facilities or services.

The project provides insights into the reasons for avoidable ED visits and could be useful in developing strategies to reduce avoidable ED visits and improve patient care.