Aligning payment reform and delivery innovation in emergency care.

Published

Journal Article

Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs. However, prospective attribution remains a challenge for EDs because of exogenous demand, which makes it important for EDs to be one of the components of capitated payment along with longitudinal providers who can exert greater control on overall care demands. The goal of payment and delivery reforms in ED care is to improve population health across the continuum of acute and longitudinal care. In order to deliver cost-conscious care, ED providers will need additional resources, expanded information, and new processes and metrics to facilitate cost-conscious decisions. Improved availability of electronic information across settings, evidence generated from developing and testing acute care-specific payment models, and engaging acute care providers directly in reform efforts will help meet these goals.

Full Text

Duke Authors

Cited Authors

  • Pines, JM; McStay, F; George, M; Wiler, JL; McClellan, M

Published Date

  • August 2016

Published In

Volume / Issue

  • 22 / 8

Start / End Page

  • 515 - 518

PubMed ID

  • 27541697

Pubmed Central ID

  • 27541697

Electronic International Standard Serial Number (EISSN)

  • 1936-2692

International Standard Serial Number (ISSN)

  • 1088-0224

Language

  • eng