CINXE.COM

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class="card:am::heading">a Broker<i class="fas fa-arrow-right"></i></h3> <div class="card:am::content"><p>What you want: healthier patients and happier employers at lower costs.</p> </div> </a> </div> </div> </div> </div> </div> <a href="https://www.vhan.com/contact-us/" class="bit:button">Contact Us<i class="fas fa-chevron-right"></i></a> <a href="https://vhanhub.com/" target="_blank" class="bit:button">VHAN Hub<i class="fas fa-chevron-right"></i></a> </nav> </div> <button class="bit:button@menu" menu> <div class="bit:button@menu::line"></div> <div class="bit:button@menu::line"></div> <div class="bit:button@menu::line"></div> </button> </div> </header> <main class="view:post"> <div class="view:post::box"> <div class="block:post"> <time class="block:post::time">02.20.2023</time> <h1 class="block:post::heading">Utilization Review Directs Patients to the Right Level of Care</h1> <div class="block:post::content"> <p>One of our key goals has been to develop a systematic approach to identify and review utilization patterns, trends and variation in care that impact quality outcomes and costs across VHAN. We started by assessing our current systems, defining data sources and identifying utilization trends.</p> <p>Next, we developed a utilization review process for high- cost claimants and identified opportunities for clinical care standardization to give network clinicians timely insight into ED utilization. We established performance goals and a method to connect patients to needed resources and the right level of care. To help VHAN practices increase access for their patients while offering secondary options for emergent care needs, we developed the VHAN ER Toolkit, available here.</p> <p>Ernie Buchanan, MD, of Upper Cumberland Family Physicians in Cookeville, TN, and VHAN Regional Medical Director, used some of the tactics from VHAN’s ER Toolkit to reduce the number of total ED visits, percent impactable (PI) visits, and overall ED paid and PI paid. Through patient education, data sharing on ED visits and updated processes (including having a live person answer the phone), unnecessary ED utilization decreased from 38% in 2019 to 31% in 2021. The percentage of potentially impactable ED costs also dropped from 40% to 26% of the total ED cost for this provider.</p> <p><strong>Looking for more stories of network impact? Visit <a rel="noreferrer noopener" href="http://vhan.com/impact" target="_blank">vhan.com/impact</a></strong></p> <hr class="wp-block-separator has-alpha-channel-opacity"/> <p>Network members can <a href="https://vhanhub.com/er-toolkit/" data-type="URL" data-id="https://vhanhub.com/er-toolkit/" target="_blank" rel="noreferrer noopener">access the VHAN ER Toolkit</a> on VHAN Hub.  </p> <p>VHAN Hub is available exclusively to network members. You must be a VHAN member and <a href="https://vhanhub.com/member-registration/" data-type="URL" data-id="https://vhanhub.com/member-registration/" target="_blank" rel="noreferrer noopener">register for the Hub</a> to gain access.</p> <p>Interested in becoming a VHAN Member and joining a collaborative group of physicians, nurses and allied professionals who are transforming health care? <a href="https://www.vhan.com/contact-us/" data-type="URL" data-id="https://www.vhan.com/contact-us/" target="_blank" rel="noreferrer noopener">Get started on the contact page</a>. </p> <p></p> </div> </div> <aside class="block:sidebar@post"> <header class="block:sidebar@post::header"> <div class="block:sidebar@post::box"> <h3 class="block:sidebar@post::heading">Latest News</h3> <div class="block:sidebar@post::action"> <a href="https://www.vhan.com/news/">View All News</a> </div> </div> </header> <div class="block:sidebar@post::items"> <article class="card:post"> <div class="card:post::box"> <h2 class="card:post::heading">VHAN Care Navigator’s Empathy Bolsters Post-Op Patient’s Emotional Well-being</h2> <div class="card:post::content"> <p>Following her gastric bypass procedure at another area hospital, a Vanderbilt University Medical Center (VUMC) employee immediately began to experience serious complications. VHAN Care Navigator Katie Crider became her advocate, going beyond clinical care to support the patient’s emotional well-being.</p> </div> </div> <div class="card:post::action"> <a href="https://www.vhan.com/vhan-care-navigators-empathy-bolsters-post-op-patients-emotional-well-being-2/" class="bit:button »small">Full Story</a> </div> </article> </div> </aside> </div> </main> <aside class="block:tagline"> <div class="block:tagline::boxed"> <div class="block:tagline::box"> <h2 class="block:tagline::heading">Improving Today.<br /> Inventing Tomorrow.</h2> <div class="block:tagline::action"> <a href="https://vhan.com/contact-us/" target="" class="bit:button »small">Contact Us Today</a> </div> </div> <div class="block:tagline::circles"> <div class="block:tagline::circle@one"></div> <div class="block:tagline::circle@two"></div> <div class="block:tagline::circle@three"></div> </div> </div> </aside> <footer class="block:footer"> <div class="block:footer::box"> <figure class="block:footer::logo"> <a href="/"><img src="https://www.vhan.com/wp-content/themes/vhan/dist/logo.svg" width="388" height="88" alt="Vanderbilt Health Affiliated Network"></a> </figure> <div class="col"> <h3 class="block:footer::heading">Quick Links</h3> <nav class="block:footer::nav"> <a href="https://www.vhan.com/about/network/about/" target="">About VHAN</a> <a href="https://vhan.com/news/?filter%5B%5D=21" target="">Changemakers</a> <a href="https://vhan.com/about/leadership/executive-leadership/" target="">Leadership</a> <a href="https://www.vhan.com/news/" target="">News</a> </nav> </div> <div class="col"> <h3 class="block:footer::heading">Tools</h3> <nav class="block:footer::nav"> <a href="https://vhan.com/wp-content/uploads/2021/12/MembershipPrinciples_MultiPageFullText_V1.5.pdf" target="_blank">Membership Principles</a> <a href="https://www.vhan.com/well-moment/" target="">Well Moment</a> <a href="https://vhanhub.com/" target="_blank">VHAN Hub</a> <a href="https://www.vhan.com/contact-us/" target="">Contact Us</a> <a href="https://vhan.com/help/#common-questions" target="">FAQ</a> </nav> </div> </div> </footer> <div class="block:colophon"> <div class="block:colophon::box"> © 2025 Vanderbilt Health Affiliated Network, <a href="https://www.vhan.com/privacy-policy/">Privacy Policy</a> </div> </div> <div class="simple-banner simple-banner-text" style="display:none !important"></div><script type="text/javascript" src="//cdnjs.cloudflare.com/ajax/libs/slick-carousel/1.9.0/slick.js?ver=6.7.1" id="slick-js"></script> <script type="text/javascript" id="app-js-extra"> /* <![CDATA[ */ var AJAX = {"rest_url":"https:\/\/www.vhan.com\/wp-json\/","admin_url":"https:\/\/www.vhan.com\/wp-admin\/admin-ajax.php"}; /* ]]> */ </script> <script type="text/javascript" src="https://www.vhan.com/wp-content/themes/vhan/dist/app.js?ver=6.7.1" id="app-js"></script> <script type="text/javascript" src="https://www.vhan.com/wp-content/plugins/page-links-to/dist/new-tab.js?ver=3.3.7" id="page-links-to-js"></script> <script type="text/javascript" src="https://www.vhan.com/wp-content/plugins/team-press/js/glightbox.min.js?ver=1.2" id="extp-lightbox-js"></script> <script type="text/javascript" src="https://www.vhan.com/wp-content/plugins/team-press/js/jquery.nicescroll.min.js?ver=1.0" id="extp-nicescroll-js"></script> <script type="text/javascript">window.NREUM||(NREUM={});NREUM.info={"beacon":"bam.nr-data.net","licenseKey":"NRJS-d3dcf83d73e98dc8516","applicationID":"1055278490","transactionName":"Z1dRZRFSCBcAURJfXl4dclIXWgkKTkEPWFZcVw==","queueTime":0,"applicationTime":626,"atts":"SxBSE1lIGxk=","errorBeacon":"bam.nr-data.net","agent":""}</script></body> </html>