Value-Based Approaches for Emergency Care in a New Era - 27/09/17

Doi : 10.1016/j.annemergmed.2016.10.031

Laura Medford-Davis, MD ^a,^b,^⁎ , David Marcozzi, MD ^c, Shantanu Agrawal, MD ^d, Brendan G. Carr, MD ^e, Emily Carrier, MD ^b
^a Baylor College of Medicine, Houston, TX
^b Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation, Baltimore, MD
^c Department of Emergency Medicine, University of Maryland, Baltimore, MD
^d Centers for Medicare & Medicaid Services Center for Program Integrity, Baltimore, MD
^e Department of Emergency Medicine, Jefferson University, Philadelphia, PA and the Emergency Care Coordination Center, Assistant Secretary for Preparedness and Response, Washington, DC

^∗Corresponding Author.

Abstract

Although emergency departments (EDs) play an integral role in the delivery of acute unscheduled care, they have not been fully integrated into broader health care reform efforts. Communication and coordination with the ambulatory environment remain limited, leaving ED care disconnected from patients’ longitudinal care. In a value-based environment focused on improving quality, decreasing costs, enhancing population health, and improving the patient experience, this oversight represents a missed opportunity for emergency care. When integrated with primary and subspecialty care, emergency care might meet the needs of patients, providers, and payers more efficiently than yet realized. This article uses the Merit-Based Incentive Payment System from the Medicare Access and CHIP Reauthorization Act as a framework to outline a strategy for improving the value of emergency care, including integrating quality and resource use measures across health care delivery settings and populations, encouraging care coordination from the ED, and implementing robust health information exchange systems.

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Plan

Introduction

The Medicare Access and CHIP Reauthorization Act of 2015

Integrating Emergency Care to Increase Value

Quality Measures That Encourage Meaningful Value in the ED

Balancing Resource Use With the Realities of the ED

Emergency-Specific Approaches to Clinical Practice Improvement

Use of Health Information Technology to Support Integration of Emergency Care Within the Care Continuum

Conclusion

	Supervising editor: David J. Magid, MD, MPH
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