How Member Education Helps Health Plans Support Better Care Decisions and Reduce Avoidable ER Use
Research Report by CARAVAN Wellness
Emergency departments play an essential role in urgent and life-threatening care. They are also used by members who are unsure where else to go, cannot access timely primary care, or do not understand the alternatives available through their health plan.
Member education cannot solve every driver of emergency department use. Access, transportation, provider availability, cost, and trust all influence care decisions. Clear, timely guidance can still help members understand their options and choose the right level of care when alternatives are available.
Why Members Choose the Emergency Department
The decision to seek emergency care is rarely based on one factor. Members may be worried that a symptom is serious, unable to reach a clinician, unfamiliar with urgent care or telehealth, or uncertain about what their plan covers.
In those moments, a general resource library is not enough. Members need simple guidance that helps them answer three questions: Is this an emergency? Who can help me decide? What options are available if it is not an emergency?
Education should never discourage someone from calling 911 or seeking emergency care for potentially life-threatening symptoms. Its role is to clarify the full care landscape before confusion becomes the deciding factor.
Make the Care Options Easy to Understand
Health plans often offer a wide range of resources, including nurse lines, telehealth, urgent care, primary care, behavioral health support, pharmacy services, and emergency care. Members may not understand the differences between them or remember how to access them when symptoms arise.
Plain-language education can explain what each option is designed to address, when it may be appropriate, how to access it, and what the member may need to pay. This guidance should be visible in the channels members already use, including mobile apps, portals, text messages, email, call centers, and printed materials.
A simple comparison can be more useful than a long policy explanation. Members need examples, not jargon. Chest pain, severe breathing difficulty, signs of stroke, or major trauma require immediate emergency attention. A minor illness, routine medication question, or non-urgent symptom may be better addressed through another care option, depending on the individual situation.
Nurse Lines and Telehealth Need Better Visibility
Many plans have invested in nurse advice lines and virtual care, but the benefit has limited value if members do not know it exists or when to use it.
Education can increase awareness before a health concern occurs. A member who has already seen clear guidance about the nurse line is more likely to remember it when uncertainty arises. The content should also explain what the service can and cannot do, so expectations remain realistic.
The Most Important Moments Are Often Transitional
Two moments deserve particular attention: immediately after a new diagnosis and immediately after an emergency department visit.
After a diagnosis, members may have questions about symptoms, medications, follow-up care, and warning signs. Without clear guidance, uncertainty can escalate into unnecessary emergency use or delayed care.
After discharge, members need to understand what happened, what to monitor, when to contact a clinician, and when to return for emergency care. Discharge education should be reinforced through accessible follow-up content, not treated as a one-time handout.
Content Should Be Connected to Action
The strongest education does not stop at explanation. It gives the member a direct next step, such as calling the nurse line, finding an in-network urgent care center, scheduling a primary care visit, starting a telehealth appointment, or reviewing emergency warning signs.
This requires coordination across content, digital product, care navigation, and member services. A well-written article that leads to a broken link or an unavailable appointment does not improve the experience.
Measure Navigation, Not Just Views
Page views alone do not show whether members made better care decisions. Plans should consider measures such as nurse-line use, telehealth activation, urgent-care navigation, follow-up appointment completion, repeat emergency visits, member confidence, and successful transitions to the next appropriate service.
Education should be evaluated as one part of a broader access and navigation strategy. It can reduce friction, but it cannot compensate for insufficient provider capacity or benefit barriers.
The Big Takeaway
Members often choose emergency care because the alternatives are unclear, difficult to access, or unfamiliar. Health plans can support better care decisions by explaining care options in plain language, promoting nurse lines and virtual care before they are needed, reinforcing education after diagnoses and emergency visits, and connecting every piece of content to a clear next step. The goal is not to steer members away from necessary emergency care. It is to make the right care easier to recognize and access.
