This project will evaluate a virtual, on-demand telemedicine program for High emergency department (ED) utilizers with comorbid physical health conditions and behavioral health correlates. Researchers will randomize patients to have either full access to the full intervention (treatment group) or to receive only standard care (control group). Analyses will be intent-to-treat. The primary outcome is the number of ED visits 120 days after the first Best Practice Alert (BPA) firing.

The research team plans to enroll 3200 patients in this study. However, randomization may end due to system constraints on December 31, 2025 before reaching that target. This sample provides 80% power to detect a 35% relative reduction in ED utilization using a two-tailed test with an alpha of .15, assuming 40% compliance with the program.

Patient presents to the ED and meets the following criteria:

Inclusion Criteria:

• 18+ years old
• 4+ Geisinger ED visits in the last 6 months
• Geisinger Health Plan (GHP) insurance member
• Has a Geisinger PCP
• Patient is being seen at one of the following facilities: Geisinger Lewistown Hospital, Geisinger Medical Center, Geisinger Bloomsburg Hospital, Geisinger Jersey Shore Hospital, Geisinger Community Medical Hospital, Geisinger Wyoming Valley, Geisinger Medical Center Muncy, Geisinger Shamokin Ach Hospital, Geisinger South Wilkes Barre

Exclusion Criteria:

• Patient being seen in departments determined ineligible by the study team
• Patient is diagnosed with alcohol and substance-related disorders
• Patient is going to receive inpatient care
• Patient is coded in the ED as Level 1 (i.e., seeking life-saving measures)
• Patient has an Intellectual Disability or Traumatic Brain Injury
• Patient is actively seeing a BH provider