Sherpaa: A Case Study in Decreasing ER & Urgent Care Usage

Sherpaa worked with a large self-insured company of ~5,000 people for 2 years. Our ultimate goal was to decrease ER and urgent care visits. After two years, over 50% of employees used Sherpaa leading to a 25% reduction in ER visits and a 36% reduction in urgent care visits, saving over $1,250,000 for the employer.

Background

Benchmarking data suggests there are about 160 ER and 560 urgent care visits per year per 1,000 employees. The CDC states that 80% of those visits are due to lack of access or “the ER is the closest place to go.” Primary care doctors aren’t accessible outside of normal weekday business hours. In New York City, there’s a 22 day wait for primary care visits and 45 days in Boston. Urgent care centers are still unnecessarily expensive, they aren’t yet widespread, and they’re not open 24 hours a day, 7 days a week.

In the 2 years prior to launching Sherpaa, this company had:

• 1,589 ER visits
• 5,525 urgent care visits

Intervention

Sherpaa, a 24/7 Online Medical Practice

Sherpaa is an online medical practice powered by physicians who can take a detailed history of the situation, order labs and imaging, and diagnose, treat, prescribe, and follow-up with patients to solve health problems over time. It’s similar to phone or video visit telehealth (traditional telehealth) in that it’s easily accessible and 24/7. But there are four main differences between traditional telehealth and Sherpaa:

#1: Employees work with the same Sherpaa doctors every day for weeks to months on end. Traditional telehealth is random doctors. A doctor who knows you and your history can do markedly more for you.

#2: Sherpaa doctors order lab and imaging tests to confirm diagnoses. Traditional telehealth can’t confirm suspicions.

#3: Sherpaa manages ~1,500 conditions. Traditional telehealth manages ~30 simple issues like pink eye and common colds.

#4: Fifty to 65% of employees use Sherpaa. Traditional telehealth is ~2–3%.

If an issue isn’t simple and straightforward, traditional telehealth will recommend an in-person visit to protect themselves from liability. Video visits are limited in scope similar to nurse practitioner visits in retail clinics. Sherpaa visits have similar capabilites to traditional primary care doctor or urgent care visits.

If you build it, will they come?

Traditional telehealth has tried this approach and usage is very low.

Here’s the secret to Sherpaa’s success:

• Educate employees in a unique, engaging way that the service is effective and trustworthy
• Deploy a data-driven solution to get ~40% of employees to enroll in Sherpaa in the first 30 days after launching and ~60% over the course of a year
• Make it free for employees to use. Access to doctors calms employees and prevents expensive utilization.
• Offer a wide-breadth of capability so employees know they can use it for anything, not just simple things like pink eye.

Results

Over 50% of employees used Sherpaa leading to a 25% reduction in ER visits and a 36% reduction in urgent care visits, saving over $1,250,000 for the employer.

Industry-leading engagement

In January 2015, Sherpaa was launched in the company with communications from the company’s CEO, the HR team, and Sherpaa’s data-driven 30-day enrollment process. After 30 days, 40% of employees had registered with Sherpaa. Over the course of one year, 60% of employees had registered with Sherpaa due to a combination of ongoing marketing efforts and employee word-of-mouth.

Ultimately, at the end of 2 years, 50% of employees had created at least one case per year. On average, those 50% of employees create 2.7 cases per year.

Markedly decreased ER and urgent care visits

After implementing Sherpaa for 2 years, this company had:

25% reduction in ER visits (1,191 down from 1,589)

36% reduction in Urgent Care visits (3,570 down from 5,525)

A savings of $1,250,000

A typical ER visit costs this company $3,000 saving the company a total of $1.2M in ER costs over the course of 2 years. An average urgent care visit costs $300 saving over $587,000 in urgent care visits. Net Sherpaa’s fees, over the course of 2 years, the company saved over $1,250,000 in ER and urgent care costs alone.

Sherpaa is an effective service that makes healthcare work for companies and employees

As deductibles rise, employees are on their own trying to spend their money in an opaque system that’s not friendly to their wallets. A trip to the ER will immediately blow through their deductible resulting in a self-insured employer picking up the rest of the year’s costs for that employee. And, an unexpected $2,000 unnecessary expenditure for an employee could be the difference between taking vacation or not. Giving employees immediately accessible doctors who can nip an issue in the bud before they spend on in-person care is a logical strategy for controlling unnecessary healthcare utilization.