Reduce Health Care Costs by Encouraging Affordable Sites of Care

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The average cost of an emergency room visit is almost 18 times higher than visiting a primary care provider. ER visits are 23 times higher than telehealth visits and more than 10 times higher than visiting an urgent care facility. This analysis from Arkansas Blue Cross and Blue Shield is based on the average cost to members of an employer-sponsored health plan in 2024. 

Average member and employer costs of visits across all Arkansas Blue Cross groups show strikingly different costs for different sites of care. In 2024, Arkansas Blue Cross group health plan members paid the following average amounts for the different types of visits*: 

• Primary care provider (PCP) routine office visits = $47.65 member cost, $99.61 employer cost (Note: one annual wellness visit for health plan members is free by federal law)
• Telehealth visits = $36.82 member cost, $54.39 employer cost
• Urgent care visits = $79.83 member cost, $76 employer cost
• ER visits = $848.06 member cost, $838.36 employer cost

A 2019 study showed that privately insured patients make 18 million non-emergency visits to emergency rooms, adding $32 billion a year to national healthcare costs.

Controlling group and individual costs

The differences in site-of-care costs are eye-opening, said Jennifer Rega, manager of clinical services and population health at Arkansas Blue Cross. 

“Medical costs across the country have been rising across the board, and we see claims trending upward in 2024,” she said. “So, it makes smart financial sense to encourage your employees to seek out the most affordable and appropriate healthcare to protect your budget and theirs. Where employees and their families go for care makes a huge difference in how much those visits cost. 

“All those individual choices by members affect their employer’s total medical costs. That means it’s in groups’ best interest to encourage their employees to use emergency rooms only for life-threatening emergencies.” 

Rega said that for several years, emergency room utilization has been decreasing for non-emergency visits, a good trend to see in an area once overrun with people accessing it for things other providers could handle more affordably and efficiently. “Thankfully, we don’t see as many people using the ER as their primary care providers these days,” she said, “but it’s still a problem, and we still have to keep an eye on how they’re being used.”

She said when her team sees a member has had several emergency visits — often for true emergencies — the nurse case managers reach out to them. “Frequent ER use shows there is a need we can address. We explain we are here to see how we can help them better manage their conditions to improve their quality of life and reduce these costly claims.” 

Communicating site of care recommendations to the workforce

Rega said that employers can help manage their health care spending by actively encouraging employees to seek out the most affordable and appropriate care for their need. “Many people just think of going to the doctor or going to the ER, without considering other options. But when employees understand the savings and added convenience, changing those habits can help eliminate excessive costs.” 

She said insurance carriers often have educational materials to share with workforces outlining site of care recommendations, among other materials. Finding opportunities to share this information can increase the value of internal communications for employees. 

“This is news they can use, information that directly affects their household budgets and how much time it takes to access healthcare. Communicating it to employees can be as simple as putting a flyer in the breakroom or an informational piece in the employee newsletter,” Rega said. 

“Another option is reaching out to your insurance company to see if someone is available to come do a Lunch and Learn or webinar for their employees. I know our Arkansas Blue Cross nurse case managers sometimes do this type of outreach.”

When to use primary care

“We love to see employers strongly encouraging their members to get and regularly visit their primary care provider,” she said. “Promoting it within the workplace can help motivate people to get a doctor even if they are generally healthy.” 

She said PCPs are the “first line of defense,” the main point of contact for routine healthcare and ongoing maintenance of chronic conditions, and overall, the first choice for most kinds of concerns. PCPs are well-equipped to diagnose a wide array of conditions, often offering more comprehensive and continuous care than the other options. Because they have their patients’ medical history, they see the full context that urgent care, telehealth and emergency physicians often do not and are best equipped to make referrals to specialists as needed.

“It’s why we recommend that in most cases that aren’t emergencies, members check with their PCPs first about getting an appointment,” she said. “They have that priceless combination of affordability and quality care because they have fuller information about your health.”

Besides the cost savings of the actual visits, getting preventive care and regular checkups helps avoid more costly treatments in the future. Rega said Arkansas Blue Cross recommends members be aware of their benefits and what kinds of healthcare delivery options their PCP clinic has available to them. For instance, some primary care facilities offer extended hours, an after-hours call line or telehealth visits. 

When to use telehealth

Rega said many insurance plans cover some form of virtual care, such as a 24-hour nurse line or telehealth conference with a physician. 

“Telehealth is a great option when people are not sure if they need to go to the doctor and when they have something that can be diagnosed virtually,” she said. “For instance, if someone tests positive for Covid, they can share that result with the telehealth provider, who could assess their symptoms and medication list, then send a prescription to their pharmacy without the patient having to leave the house.

“Or, if your child has a rash that you’re unsure if a doctor should see, or you don’t know if symptoms are significant enough for an office visit, calling a virtual health provider can give you guidance and peace of mind that you’re responding appropriately.”

When to use urgent care

Many communities now have an urgent care clinic even if they do not have a hospital. Rega said these facilities exist to treat medical issues that require prompt attention but are not life-threatening. Minor injuries like sprains, fractures, burns and cuts are good candidates for urgent care if seeing a PCP quickly is not an option. Urgent care clinics also treat concerns like sore throats, coughs, stomach bugs, minor asthma flare-ups and non-life threatening allergic reactions. 

“The great advantage of urgent care clinics is that people are often available to get seen right away, whereas PCPs may not have same-day appointments available. They also have extended hours so people can be seen during evenings and weekends,” Rega said. 

Urgent care visit costs are higher than primary care visits but far less than visiting the ER. She said many patients who go to the ER for something like a broken arm or a fever could be more quickly and affordably treated at an urgent care clinic, but there are still a lot of people who have never visited one. “They’re not on everyone’s radar yet.” 

Rega said some insurers now offer another option: in-home urgent care. “Some health plans have a vendor that can make house calls for urgent care visits, usually the same day. That is another trend we are starting to see,” she said. “It has the convenience of telehealth while receiving an in-person exam.”

When to use the ER

Emergency rooms exist to treat severe and life-threatening conditions like severe trauma and critical health conditions like strokes, heart attacks and severe respiratory distress. Emergency rooms at hospitals and standalone emergency facilities have sophisticated equipment and diagnostic tools like CT and MRI scans and access to on-call specialists, resources that primary care and urgent care clinics do not. 

“It’s so important for workforces to understand that emergency rooms are best reserved for true emergencies,” Rega said. “Unchecked ER visits are a major driver of costs for groups and families, so whatever we can do to get people seen for non-emergency needs at non-emergency facilities makes a difference. It also helps keep the emergency health providers free to give their full attention to those there for severe, critical care.

 “Why risk getting a bill of $850 at the ER when you could see another provider more quickly for less than $80? Making informed choices about where to seek care helps employees get effective treatment while optimizing the benefits you offer.” 

*Costs are for the visits, not including extra tests or costs of medications and treatment.