Hospitals expand push to limit ER visits ahead of Medicaid cuts

For transformative EMS agencies, the message from hospitals should be clear: this is an opportunity to become part of the solution.

Health systems are increasingly investing in care navigation, virtual care, behavioral health, urgent care, and other strategies designed to keep patients with non-emergent needs out of already crowded emergency departments, efforts that have demonstrated meaningful reductions in avoidable ED utilization and costs.

EMS agencies are uniquely positioned to become valuable partners in this work through Treatment in Place, Mobile Integrated Healthcare/Community Paramedicine, telehealth-enabled field care, behavioral health navigation, and post-discharge or high-utilizer programs. Cleveland Clinic’s model is particularly instructive: emergency physicians can consult directly with paramedics in the field, order diagnostics, prescribe medications, and coordinate follow-up care.

Rather than waiting for hospitals to develop these strategies around EMS, forward-thinking agencies should be approaching their hospital partners now and asking: Which patients are unnecessarily reaching your ED, what is driving those visits, and how can we help manage those patients safely somewhere else?

As hospitals confront increasing ED demand and financial pressure, EMS has an opportunity to evolve from simply being the transportation pathway to becoming an integral part of the health system’s care-navigation strategy.

Hospitals expand push to limit ER visits ahead of Medicaid cuts
By Alex Kacik
October 02, 2026
 
https://www.modernhealthcare.com/providers/mh-hospital-er-urgent-care-virtual/
 
Key Takeaways

• Health systems are expanding care navigation programs amid ACA and Medicaid policy changes that are expected increase emergency department visits.
• The growing programs and care networks have reduced avoidable emergency department visits and reduced costs.
• Health system executives recommend improving communication with community partners and increasing telehealth capacity.

Health systems are broadening efforts to steer patients who don’t need emergency care to more appropriate lower-cost settings.

Providers look to increase revenue and lower operating costs by expanding care-navigation programs and sites outside of the hospital, to free emergency department capacity for high-acuity cases. The push comes as they race against Affordable Care Act and Medicaid policy changes that are poised to increase emergency department utilization over the next year.

“Folks who don’t have insurance, miss preventative care and come last minute to the emergency room at higher volume and higher acuity is a very big concern,” said Dr. Bryan Graham, division chair of urgent and Express Care at Cleveland Clinic.

Many people go to the emergency department even though they often could receive treatment quicker and pay less at urgent care centers and clinics. That is particularly true for mental health patients who swarmed hospital emergency rooms during the COVID-19 pandemic.

WellSpan Health is among many health systems that have worked to reduce emergency department overcrowding.

In April, the health system opened a walk-in crisis center at its community behavioral health clinic near its main hospital campus in York, Pennsylvania. This month, the health system plans to open a new behavioral health clinic in Adams County.

WellSpan opened the clinic in 2020 after receiving a federal grant for providers trying to increase mental healthcare access. The grant helped fund team-based care, where clinicians and social workers coordinate therapy, medication support and other services, said Mitchell Crawford, medical director of addiction services at WellSpan. Clinicians connect patients to social services, such as housing shelters and food pantries, helping reduce emergency department visits.

Recent results have fueled expansion plans. Roughly 3,500 patients who visited WellSpan’s behavioral health clinic last year said they would have otherwise gone to the emergency department, said Michele Crosson, project director of the Specialized Treatment and Recovery Team at WellSpan.

“We need to have strong relationships with primary care providers, outpatient facilities and community programs so there are good care transitions,” Crosson said. “Sometimes people are just lonely and need help.”

WellSpan also has tried to reroute emergency department-bound patients dealing with heart failure.

Clinicians often would send patients who called the nurse triage call center with fluid retention or shortness of breath to the emergency room. Instead, the health system set up a new symptom-based system that ranks urgency by color. A yellow-coded patient could receive a diuretic at a clinic and be sent home, for instance, said Dr. David Gasperack, chief medical officer of WellSpan Medical Group.

The system helped decrease avoidable emergency department visits by 11.2% in 2025, reducing care costs by nearly $3.4 million, he said.

Temple Health also looked to reduce heart failure-related emergency department visits when in 2020 it opened a clinic that provides wraparound care for frequent emergency department and hospital patients. The program has since expanded to all types of patients.

The clinic, located on the main hospital campus in Philadelphia, has helped reduce emergency department visits by about 40% annually, said Steven Carson, senior vice president of population health at Temple.

In August, Temple opened a second clinic about four blocks away in partnership with Fair Hill Community Physicians, a federally qualified health center.

Patients are coming to the emergency department for more than treatment, such as transportation, food, a shower and clothes, Carson said.

“We went into this naively, assuming we knew what they needed. We were wrong,” he said. “We’re now doing root-cause analysis of why each patient is coming back.”

Hartford HealthCare and Cleveland Clinic have expanded both their physical and virtual care networks as demand for care grows.

In August, Hartford HealthCare, in partnership with urgent care operator GoHealth, opened its largest urgent care center among the 50 in its network, said Jeffrey Flaks, president and CEO of Hartford HealthCare.

The new facility, which is near its main hospital campus in northern Connecticut, has treated about 30 to 40 low-acuity patients a day since it opened, he said.

Emergency department volumes already have started to slightly decline, Flaks said. “We see this as something we can do in other hospital campuses,” he said.

Cleveland Clinic started a virtual emergency medicine program in 2021 across select Ohio hospitals. The system has since expanded it to all its Ohio hospitals while also opening new urgent care locations. The program has reduced transfers from urgent and Express Care sites to emergency departments by about 30% annually, Cleveland Clinic’s Graham said.

Emergency medicine doctors can consult with patients in their hospital emergency departments or with paramedics in the field using internally designed custom Microsoft Teams software. Remote physicians can order diagnostic tests, prescribe medication and direct follow-up care.

“This is now a major part of our emergency department operations as volumes continue to rise,” Graham said.