Managed care enrollee utilization of 911 medical services

Objective. To determine the mechanism by which managed care organization (MCO) enrollees enter the emergency medical services (EMS) system. Methods. All enrollees belonging to the region's largest MCO and transported to emergency departments by a paramedic-level municipal EMS system were identified from billing records. Dispatch logs were examined to determine the time and origin of the call to the 911 communication center. Patient care records were used to obtain age, the level of care delivered (advanced or basic life support), and whether the patient received any medications while out of hospital. Hospital admission was also determined. Results. Over a six-month period, 195 enrollees were transported. Three modes of 911 EMS system entry were identified: group I-enrollees who called 911 directly; group 11-enrollees who called the MCO triage center, who then called 911 on behalf of the patient; and group III-enrollees who were sent to the MCO health center for evaluation, and subsequently the MCO called ...