Read Chapter $9$ Case Study $-$ Anthem$$s Avoidable ER Policy

Case studies provide an excellent class method to explore chapter concepts in work settings. The

majority of the cases at the end of the chapters in this text come from real situations that have

been faced by healthcare managers. The intent of having you do these short cases is to engage you to gain a better understanding of the chapter concepts and to apply the concepts to develop reasonable answers to the cases$$ questions.$$ Similar to what you do in a real healthcare management role.

A recommended procedure for addressing the case studies is:

Read and examine the case thoroughly.

$-$ Decide what the key issue or issues is$/$are in the case.

Focus your analysis

$-$ What class materials are relevant to the case?

Uncover possible solutions applying class materials.

$-$ Brainstorm to generate different potential solutions$/$answers to the case questions.

$-$ Make sure that the solutions are tied back to class materials.

Finalize your submission.

$-$ Support your ideas and answers.

Your submission for each case assignment is to be completed in a professional manner and formatted in the form of a report to healthcare colleagues or leaders for their evaluation.$$ Your submission should begin with a summary of the key issue$($s$)$ in the case, and then a clear, concise, well formatted narrative that addresses all the questions in the case. The expected length of your submission is two pages, double spaced, using $1$ margins. This does not include a cover page or reference list $($if used$).$ Cases

Anthem's Avoidable Emergency Room Policy

Anthem, one of the largest healthcare insurers in the United States, implemented an "avoidable ER$"$ policy to help manage the care of its enrollees. The policy stated that Anthem would not pay for emergency room visits if the company determined that the visit was not necessary. The policy, which was instituted in six states beginning in $2015,$ was meant to encourage patients to seek care in appropriate settings. However, providers feel that this policy might cause patients to avoid emergency treatment, even when it is necessary. In response to customer and provider complaints, Anthem created several exceptions: Claims will be covered if a healthcare provider tells a patient to go to the emergency room, if the patient is under $15$ years of age, if the patient is outside his or her state of residence, and if the patient had a CT scan or MRI or underwent surgery. Still, providers are unhappy with the policy $($Livingston $2018).$