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Emergency departments (EDs) nationwide are facing unprecedented strain. High rates of repeat visits, extended wait times, and escalating costs are stretching hospital systems to their limits—and placing added pressure on local governments that ultimately shoulder the impact of poor health outcomes.

The numbers paint an alarming picture: 

• Average patient wait time of 2 hours and 42 minutes in the ED in the United States.
• Wait times of more than 3-5 hours for several states signal inefficiencies and avoidable costs
• Twice as long wait times in rural areas are driven by scarce primary care and clinic closures

It’s tempting to treat preventable ED utilization as an isolated capacity issue. But if we’re willing to listen, ED utilization rates are a warning cry to county and city leaders across America, calling out exactly where our systems are breaking down.
 

The ED as a Systems Indicator

Research shows that nonmedical needs directly drive higher ED utilization. When nonmedical barriers remain unaddressed, patients cycle right back through the ED. 

Many preventable ED visits stem from unmet needs that arise long before someone arrives at the hospital in a crisis:

• A resident with uncontrolled diabetes who lacks consistent access to insulin.
• An individual in crisis who never received behavioral health follow-up after discharge from a hospital visit the previous month. 
• A patient who was referred to social services but never actually received support. 

These are not isolated issues, but evidence of systemic failure that impacts health care, behavioral health, housing, and other social services.

Overextended emergency departments may face unique challenges and be located in different zip codes, but the communities they serve share common challenges: referrals are sent but rarely tracked, agencies operate without visibility into one another’s interventions, and outcomes are measured in silos. The end result is the same—emergency departments become the default safety net.
 

What Changes When Systems Coordinate

It doesn’t have to be this way. In communities across the country, a different story is unfolding.

In Southwest Virginia, patients engaged by community health workers through coordinated referral processes enabled by Unite Us experienced a 24.8% average decrease in emergency department visits in the six months following engagement.

In North Carolina, coordinated interventions supported through Unite Us were associated with an estimated reduction of six ED visits per 1,000 members per month, in addition to cost savings of approximately $1,000 per member annually. 

Other communities using Unite Us to connect health care providers, public agencies, and community-based organizations have documented measurable improvements in upstream indicators, including:

• Eighteen percent increase in behavioral health follow-ups after an ED visit.
• An increase of 19.6% in controlled blood pressure.
• Improvements in food security and reductions in A1C levels among participants in nutrition-focused programs

No single intervention can claim responsibility for these results. They emerged from coordinated action—enabled by shared technology and clear accountability across partners. Closed-loop referrals prevented residents from falling through the cracks, and shared data provided visibility into whether services actually improved outcomes.

The lesson is clear: when communities truly close the loop on care, emergency utilization decreases and overall health outcomes improve.
 

Listening Requires Infrastructure

Most city and county leaders already understand that health outcomes are influenced by more than healthcare delivery alone. Housing stability, food access, behavioral health services and transportation all play a clear role. 

But just as local governments invest in roads or broadband to connect communities physically, they must invest in infrastructure that connects systems operationally. In many counties and cities, Unite Us serves as that secure, cross-sector infrastructure—supporting closed-loop referrals, enabling secure data sharing, and giving leaders visibility into outcomes across departments and community partners.

Without this foundation, even well-designed programs operate in isolation. With it, communities can align agencies, close gaps in care, and prevent crises before they escalate into emergency visits.
 

A Leadership Opportunity

Emergency department utilization sits squarely at the intersection of core local government responsibilities—responsible budgeting, agency performance, and accountability to the public. At a time when residents rightfully expect measurable outcomes and funding is increasingly tied to demonstrated results, leaders have a powerful opportunity to align limited resources around strategies that deliver tangible, lasting progress.

Within that context, emergency departments offer more than insight into system strain—they provide a roadmap for improvement. They tell us where coordination can be strengthened and where earlier intervention can prevent crises altogether. 

When governments invest in stronger alignment across healthcare providers, public agencies, and community-based organizations, the benefits compound: preventable emergency visits decline, chronic diseases are better controlled, behavioral health connections improve, and social needs are addressed before they escalate. At the same time, shared infrastructure creates the transparency necessary to measure results and clearly demonstrate impact to residents and funders alike.

Emergency departments are not simply endpoints in the system, but guideposts for transformation. For local leaders, the opportunity is clear: build systems capable of responding to these signals and turn them into measurable progress in health outcomes.

Learn more about how Unite Us can help reduce emergency department utilization by addressing drivers of health.