In 2023, emergency departments logged 119,605 heat-related illness visits across the United States, and 92% of them landed between May and September [1]. That spike is not random, and it is not evenly distributed. It clusters in the warm-season months, in the hottest regions, and in the patients your practice already knows are fragile — older adults, people on multiple chronic-condition medications, and members whose housing does not cool down at night. The work of cutting extreme heat avoidable ED visits through panel management starts well before the first dangerous-heat day, because by the time the heat index spikes, the at-risk patient is already in the waiting room of an ED instead of yours.

The Predictable Spike Nobody Schedules For

Heat is one of the few clinical risks with a calendar. Heat-related illness ED rates roughly tripled in July and August of 2023 — 303 visits per 100,000 ED visits, against 97 in the shoulder months [1]. The burden concentrates geographically, too: the federal region covering Texas and Louisiana posted the highest rate in the country at 483 per 100,000, with more than a third of warm-season days exceeding the local historical heat threshold [1]. And the deaths behind these visits are, in the words of the CDC, “generally considered preventable” — roughly 702 a year on average [2].

What makes a predictable, seasonal, preventable spike so costly is that the fee-for-service reflex is to absorb it. The patient decompensates, presents to the ED, and the visit shows up later as an emergency-department-utilization or readmission line on your value-based scorecard. We think the better move is to intercept the cohort before the season, not after the claim.

Identifying and Reaching the Heat-Vulnerable Cohort

The patients most likely to convert a heat wave into an ED visit are not a mystery. They are, in large part, the cohort your risk model already flags.

Identifying the cohort through High Risk Member Management (HRM)

EH’s HRM program already defines a tightly stratified at-risk group: members in the top 10 to 25% of risk per the Johns Hopkins ACG Case-Mix System, with a greater than 10% hospitalization probability, and at least one uncontrolled or rising-risk chronic condition — diabetes, heart disease, chronic kidney disease, asthma, COPD, or depression [3]. That definition overlaps almost exactly with the heat-vulnerability profile. The CDC notes that older adults regulate temperature less effectively, that conditions such as heart disease and poor circulation raise risk, and that common medications — including diuretics, and an ACE inhibitor or ARB combined with a diuretic — sensitize patients to heat [4]. Your HRM panel is, functionally, a heat-risk panel.

CareEmpower®’s risk-stratified Worklist surfaces that panel. Its sorting logic is based on payer contracts and risk levels [5], so the members who most need a pre-heat touch rise toward the top rather than getting buried.

Dry heat and humid heat: one trigger across five states

Arizona practices know the dry-heat signal. The four humid-heat states — Texas, Tennessee, Louisiana, and Virginia — face a different and less intuitive threat: the heat index. When the air holds moisture, sweat cannot evaporate, so the body cannot shed heat.

At 100°F air temperature with 55% relative humidity, it feels like 124°F [6]. Direct sun can add up to another 15°F, and the danger zone for heat disorders begins at a heat index of 103°F [6]. The practical takeaway: in the humid-heat states, the dangerous day arrives at a far lower thermometer reading than Arizona’s 110°. Watch the feels-like number, not the air temperature.

The Patient Engagement filter: finding who you haven’t seen

The highest-risk heat patient is often the one you haven’t laid eyes on in a year. CareEmpower’s Patient Engagement filter flags members with no interaction with any practice in the last 18 months [5]. Those are the members panel management exists to catch — the ones who, under fee-for-service, simply would not appear until something broke.

Putting the Pre-Heat Pull Into Motion

The panel is who is attributed, not who shows up. Under value-based care, you are responsible for every attributed member, not only the ones who book appointments [7]. A disengaged member with uncontrolled chronic kidney disease does not stop being your patient because he hasn’t called — he stops being visible. Pulling the HRM cohort from the CareEmpower® Worklist and layering the Patient Engagement filter on top turns an invisible liability into a named outreach list before heat season, not after.

Your front desk cannot make forty pre-heat calls. Identifying the cohort is only half the work; someone has to reach them. For practices that opt in, the EH Care Team — including Community Health Workers (CHWs) — can run a pre-heat check-in, confirming the member has working cooling, a medication-refill plan, and a way to reach you before they reach an ED. CHWs are the frontline for exactly the food, housing, and resource needs that turn heat into a crisis.

Heat vulnerability is real but uncoded. When a member’s home does not cool safely, that is a codeable clinical finding, not just a note. Z59.11 — inadequate housing, environmental temperature — captures it as a social determinant of health (SDOH), and EH’s SDOH workflow routes the member to CareEmpower’s referral and FindHelp resources [8]. Coding it makes the risk visible to the next encounter and to the panel.

The Season Is on the Calendar. The Visit Doesn’t Have to Be.

Heat is the rare clinical risk you can see coming months out. Take the 71-year-old with chronic kidney disease and heart failure, on a diuretic and an ARB — squarely inside both the HRM definition and the CDC heat-risk profile [3][4]. Under fee-for-service he surfaces in mid-July as a heat-and-dehydration ED visit and a readmission risk; pulled from the Worklist in June and reached by a CHW check-in, he gets a medication review, a cooling-access conversation, and a Z59.11 code instead. Same member, same risk — only the timing changed, and the ED visit was avoided.

Practices that pull their heat-vulnerable panel before the heat index spikes do not just lower their extreme heat avoidable ED visits through panel management — they meet a fragile patient with a plan instead of meeting a claim with a sigh. With the right pull, the ED visit does not have to be.

References

[1] Centers for Disease Control and Prevention. “Heat-Related Emergency Department Visits — United States, May–September 2023.” MMWR Vol. 73, No. 15, April 18, 2024. cdc.gov/mmwr/volumes/73/wr/mm7315a1.htm

[2] Centers for Disease Control and Prevention. “Heat-Related Deaths — United States, 2004–2018.” MMWR Vol. 69, No. 24. cdc.gov/mmwr/volumes/69/wr/mm6924a1.htm

[3] Equality Health. High Risk Member Management (HRM) — Pathways to Better provider guide (June 2025). Eligibility per Johns Hopkins ACG Case-Mix System.

[4] Centers for Disease Control and Prevention. Heat and older adults; heat and chronic conditions (risk factors, including heat-sensitizing medications). cdc.gov/heat-health

[5] Equality Health. CareEmpower® Worklist Training Guide (November 2025). Patient Engagement filter; risk- and payer-contract-based prioritization.

[6] National Weather Service. “What is the Heat Index?” weather.gov/ama/heatindex

[7] Equality Health. Practice Transformation Playbook (December 2024), Panel Management — responsibility for all attributed patients, not only those who present.

[8] Equality Health. SDOH Quality Guide (March 2025). Z59.11 (inadequate housing, environmental temperature); CareEmpower FindHelp referral integration.