St. Louis-based Ascension is on track to reduce avoidable emergency department visits by 5% within just two years across most of the markets it operates in across 19 states.
Behind this progress is a deep commitment to addressing social determinants of health needs in vulnerable patient populations, Stacy Garrett-Ray, MD, senior vice president and chief community impact officer at the health system, told Becker’s.
“Eighty percent of our health outcomes are impacted in spaces outside of access to care,” she said. “If you aren’t able to have a ride to get to your care, or you are having challenges just paying for food, or for your electricity bill or rent, you are faced with very challenging decisions, and sometimes those decisions don’t allow you to get care in the right place, at the right time.”
What’s driving down preventable ED visits?
Over the past several years, Ascension has conducted more than 4 million social determinants of health surveys. Pairing insights gleaned from that data with community input has allowed it to address disparities at scale.
In 2024, Ascension cared for about 1.2 million Medicaid and self-insured patients, with data showing around 60% of those patients entered the system through the emergency department. One of the system’s clinical priority goals for this year is connecting more patients to primary care, especially in regions where ED utilization for nonemergent needs is high.
“When we started this clinical priority goal, we were very intentional to have it be data driven, but also community informed,” Dr. Garrett-Ray said.
A dashboard created by Ascension’s Data Science Institute — established in 2019 — enables leaders at the system and market level to pinpoint what social factors are affecting patients’ ability to seek timely care in the appropriate setting. The data can be broken down by a range of factors, including payer type and neighborhood.
When barriers are identified, Ascension leverages its partnerships with community organizations and federally qualified health centers to ensure patients receive support to overcome barriers they may be facing, whether related to medication access, food insecurity, transportation or housing. The health system’s case management teams and community health navigators also play a key role in building trust with patients through outreach and consistent follow-up.
“They’re not someone who is just on a phone and in a different space, but they know some of the challenges within the community,” Dr. Garrett-Ray said. “So they can say, ‘Ms. Smith, I see that you came in for diabetes and that you had answered [on a survey] that you have challenges with food currently. Let’s try to find you some other resources.'”
In one example, SDOH data helped Dell Children’s Medical Center in Austin, Texas, identify that some of the highest ED utilizers for preventable conditions were living in one specific apartment complex. Community navigator teams at the hospital did outreach and found that individuals living in the community faced challenges with transportation and determining when to seek care at an urgent care center or primary care provider.
“They actually are one of our top-performing markets now,” Dr. Garrett-Ray said.
Progress in reducing preventable ED visits has been a critical part of Ascension’s financial turnaround, according to the system’s CFO, Saurabh Tripathi.
“In geographies with complex, chronic patients going straight to the ED, we’ve asked: ‘Can we redirect them to urgent care or primary care earlier?” Mr. Tripathi said during an April 29 panel at Becker’s 15th Annual Meeting. “It’s the right thing for patients, keeping them out of acute care when it’s not needed. It’s right for providers, reducing the cost of care. And frankly, insurers appreciate it too, since claims are significantly lower under that model.”
Ascension reported a $3 billion operating loss in fiscal 2023. It has since achieved a $2.6 billion net turnaround.
Lessons for other systems: Start with what you have
Even health systems without a formal data science institute or expansive infrastructure can take meaningful steps to reduce preventable ED use, Dr. Garrett-Ray said. Her advice to leaders: Start with the data you already have.
“There is data that’s in front of you that can help you understand some of the needs within the community, especially when you’re thinking about Medicaid and uninsured [populations],” she said. “What are some of the conditions people are frequently coming in for? Am I able to identify whether or not there are certain ZIP codes where utilization is highest?”
She encouraged teams to align around these insights and recognize the value of making them visible. From there, leaders can build targeted strategies to address barriers to care patients are facing in certain communities.
“But you have to make it a priority,” she said. “It should be a part of your quality.”
