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MCO Serving Medicaid Members
Executive Summary
Emergency department (ED) utilization is one of the costliest and most preventable drivers of healthcare spending in Medicaid populations—particularly among members with substance use and behavioral health conditions.
New claims data from an MCO serving Medicaid members demonstrates that WEconnect Health significantly reduced avoidable ED visits and associated costs. By supporting members with daily digital engagement, behavioral incentives, and 24/7 peer access, WEconnect helped reduce emergency department claim volume by 47% and cut total ED-related costs by over 40%.
This reduction translated to more than $750,000 in total savings and a 57.8% decrease in average per-member-per-month (PMPM) ED costs—confirming WEconnect’s role as an effective solution to reduce avoidable emergency care and stabilize high-risk member populations.
Key Results
The Challenge: High Emergency Department Utilization in Medicaid
For Medicaid MCOs, frequent emergency department usage is a key indicator of care disruption. Many members with substance use or behavioral health challenges cycle through EDs due to lack of ongoing support, missed appointments, and untreated relapses. Each visit represents a missed opportunity for preventative care—and a high-cost impact on the system.
Reducing unnecessary ED visits not only improves health outcomes, but also helps Medicaid plans reinvest in more proactive, evidence-based services.
The Solution: Daily Engagement with WEconnect
WEconnect Health addresses ED overutilization by offering a proactive, tech-enabled recovery support platform that:
- Reinforces healthy behaviors through contingency management
- Provides 24/7 peer support and online recovery meetings
- Encourages daily check-ins and goal completion
- Keeps members connected to their recovery and out of crisis
Instead of reacting to symptoms after an ED visit, WEconnect supports members before they reach a breaking point—promoting stability, accountability, and engagement in healthier routines.
Claims Impact: Significant Reduction in ED Visits and Costs
Since the start of the WEconnect program:
- ED visit counts dropped from 1,642 to 870
- Total emergency claim costs decreased by more than $750,000
- Average monthly ED-related costs per member were cut from $438 to $185—a 57.76% reduction
These results underscore WEconnect’s impact in helping Medicaid members avoid crisis-level care and stay connected to more cost-effective recovery pathways.
Implications for Medicaid MCOs
WEconnect’s ED claims data reinforces its value for MCOs seeking to:
- Prevent unnecessary emergency care
- Reduce high-cost utilization among SUD and behavioral health populations
- Improve member quality of life through daily digital support
- Deploy a scalable, evidence-based intervention with measurable ROI
By lowering reliance on emergency services, WEconnect allows Medicaid plans to invest in proactive engagement that keeps members healthier and costs lower.
Conclusion
This case study shows that WEconnect Health not only improves member engagement—but significantly reduces emergency department utilization and associated costs. With over $750,000 in verified ED savings and a 47% reduction in visits, WEconnect demonstrates real-world impact at scale.
For Medicaid MCOs ready to reduce claims and elevate care, WEconnect is a proven partner in recovery-focused, cost-effective digital support. Reach out today.
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