Guide Patients to Better Care Paths
Emergency rooms were designed for emergencies. They have become, instead, a pressure valve for everything else.
A headache that lingered too long. A medication refill that never came. A chronic condition that quietly worsened until it could no longer be ignored. By the time a patient reaches the ER, the story has already unfolded; missed signals, delayed outreach, fragmented care. The visit may feel sudden, but it rarely is.
Across health systems, a significant portion of ER utilization is avoidable. Not unnecessary; patients seek care for valid reasons but avoidable in the sense that earlier intervention, clearer guidance, or better care navigation could have changed the outcome. The challenge has never been intent. It has been foresight.
The Problem with Reacting Too Late
Most organizations know the cost of avoidable ER visits. Fewer can see them coming.
Traditional population risk models tend to focus on broad categories: high-cost patients, chronic disease cohorts, and historical utilization. What they miss is the in-between space—the patient who is not yet at high risk but no longer at low risk either. The rising-risk member whose conditions are escalating quietly, outside the reach of static reports and retrospective claims analysis.
Without proactive insight, teams face familiar constraints:
- Limited visibility into worsening conditions before they turn acute
- No structured way to intervene before an ER visit occurs
- Generic risk scores that explain little and predict less
- Outreach that arrives late, if at all
- Preventable emergency utilization that continues to strain budgets and care teams alike
The result is not just a higher cost. It is care delivered at the wrong place, at the wrong time.
A More Anticipatory Approach
Hexplora’s ER Predictor is built around a simple premise: avoidable ER visits follow patterns. If those patterns can be identified early and acted upon thoughtfully, care can move upstream.
Rather than treating emergency utilization as a fait accompli, ER Predictor focuses on prediction and prevention. It analyzes a wide range of signals; medical history, utilization trends, behavioral patterns, and social determinants of health to surface members at elevated risk of avoidable ER use before they arrive at the hospital doors.
The emphasis is not just on scoring risk, but on understanding it.
What Makes ER Predictor Different
Explainable Risk, Not Black Boxes
ER Predictor doesn’t simply flag patients; it shows why. Care teams can see the drivers behind each risk score, enabling more informed, more human decisions about outreach and intervention.
Real-Time Intelligence
Risk is dynamic. ER Predictor updates continuously, capturing changes in utilization patterns and behaviors as they occur, so teams are working with what’s happening now, not what happened months ago.
Action Pathways, Not Just Insights
Prediction without action changes nothing. Hexplora automatically routes rising-risk members toward appropriate care channels—digital care, urgent care, or care management—based on context and need.
Built for Care Navigation
Smart alerts and follow-up workflows help teams intervene early, guide patients toward the right setting, and prevent escalation. The goal is not avoidance for its own sake, but alignment: matching patient needs with the most appropriate care.
Population-Level Visibility
Beyond individual members, ER Predictor reveals broader utilization drivers across the population, helping organizations understand where and why avoidable ER use is occurring, and how to address it systematically.
The Impact
With ER Predictor, organizations can:
- Reduce unnecessary ER visits
- Improve patient guidance toward appropriate care channels
- Support timely outpatient and preventive care
- Reduce total cost of care in risk-bearing models
- Strengthen care coordination, patient support, and engagement
It allows care teams to work earlier, when intervention is still possible, and relationships still matter.
Who It’s For
ER Predictor is designed for organizations that carry both clinical responsibility and financial risk:
- Health plans
- Provider organizations operating under risk contracts
- ACOs and clinically integrated networks
- Emergency care steering and utilization management teams
- Population health and care management leaders
In each case, the objective is the same: fewer emergencies that could have been prevented, and better care journeys for the patients behind them.
Seeing the Emergency Before It Happens
Avoidable ER visits are not failures. They are signals of systems that did not see, or could not act, in time.
ER Predictor shifts that equation. By making rising risk visible and actionable, it gives organizations the chance to intervene earlier, guide patients more effectively, and reserve emergency care for when it is truly needed.
Request a demo to see ER Predictor in action.
