Meet 22-year-old John. He’s visiting his older sister, Ann, on Monday evening when he starts to throw-up and develops severe abdominal pain. John is in pain and Ann is scared. At around 7 p.m., Ann takes him to the urgent care center a block from her apartment.
Due to his persistent vomiting and history of kidney stones, John is sent to the closest emergency department (ED). He typically goes to a different hospital in town closer to his apartment and had a CT scan there last week. There is no health information exchange shared by the competing hospitals. Phone calls to the other hospital result in a faxed medical record release form that will sit in medical records until the daytime clerk’s next shift. Without the ability to access John’s recent imaging studies, the emergency physician orders another CT scan, increasing cost and radiation exposure.
As John’s case demonstrates, emergency and acute care touches Americans’ lives, and the way this care is delivered is ripe for change. We need a more integrated and patient-centered way to deliver care during our most vulnerable moments.
So, how can we help John get the individualized care he needs?
Challenges facing the healthcare system are being addressed by the delivery system reform initiative announced by Health and Human Services’ (HHS) Secretary Burwell last year. The Secretary outlined a vision to ensure all healthcare delivery components are patient-centered by supporting better care, smarter spending, and healthier people through:
- Incentives: Bringing proven payment models to scale, aligning quality measures, and promoting value-based payment systems by testing new alternative payment models (APMs) and increasing the linkage of Medicaid, Medicare fee-for-service, and other payments to value. HHS announced that 30% of Medicare payments will be tied to quality through APMs by the end of 2016 and 50% by the end of 2018. By the end of 2016, 85% of all Medicare fee-for-service payments will be tied to quality or value, reaching 90% by the end of 2018.
- Care Delivery: Bolstering the integration and coordination of clinical care services throughout the healthcare continuum of care, improving population health, and promoting patient engagement via shared decision making.
- Information: Creating transparency on cost and quality information, bringing electronic health information to the point of care for meaningful use, and supporting joint consumer and clinical decision making.
Many important factors will shape healthcare delivery in the future, and medical success stories are integral in advancing healthcare to be patient-and community-centered. Key among these are changes in population demographics such as an aging population, an increased proportion of the population who lives with multiple chronic medical conditions, rapidly evolving innovation in technology, and the extension of a consumer culture into the healthcare marketplace. Many of these factors are relevant in the emergency and acute care setting as chronically ill and medically complex patients with fragmented healthcare seek outpatient solutions that don’t yet exist when they get sick.
Changes in healthcare delivery and payment models are shifting from volume-based care to value-based care. This is a critical time for the acute care system to connect the dots between providers, be the just-in-time solution when patients are sick, injured, and scared, and deliver on the promise of a better, smarter, and healthier U.S. healthcare system.
Stay tuned to read about the evolving role of acute and emergency care reform as part of this three-part series.
This blog post is the first part of a three-part series that discusses how the emergency and acute care system can be reformed to ensure patient-centeredness, integration into the broader healthcare system, high-quality, and the ability to respond to public health emergencies and disasters. To stay up-to-date as new blog posts are published, subscribe to the ASPR Blog RSS feed, follow @PHEgov on Twitter, Like us on Facebook or follow us on LinkedIn.
