SPECIAL BLOG SERIES: A “How-to” on Integrating Value-based Care Models into Existing Contracts

Welcome back to the special blog series that ACEP is doing with the Geriatric Emergency Department Collaborative (GEDC), as well as West Health and The John A Hartford Foundation! These blog posts delve into the concept of value-based care in emergency medicine.

As a reminder, the first blog post in the series, posted in May 2022, provided an overview of value-based care and highlighted some of the initial work being done within emergency medicine to improve the quality of care delivered and lower costs. We particularly focused on the advent of geriatric emergency departments (GEDs), which incorporate specially trained staff and assess older patients in a more comprehensive way. In 2018, ACEP launched the Geriatric Emergency Department Accreditation program which established criteria for three levels of GED accreditation. There are now over 371 accredited GEDs in the US, along with a growing presence internationally.

Next, in July 2022, we published a second blog post that dove deeper and discussed some of the challenges emergency medicine faces moving towards participating in value-based care payment models and what we collectively need to do to advance this movement. In the end, we made the post a call to action both for you as emergency physicians and for policymakers. It’s time to truly realize the potential of emergency physicians to influence health care quality and cost and engage them in value-based care initiatives and to change the perception of an emergency department (ED) visit as a failure in the system to an opportunity for changing patients’ care and cost trajectories.

We acknowledge that we have highlighted quite a few challenges that emergency medicine still needs to overcome to move to value-based payment. However, we want to let you know that it is possible to make this transition now! You can seize the moment and work with private payors to convert your fee-for-service (FFS) payment contracts into value-based contracts.

How do you do this, you may ask? How should you even approach the idea of value-based contracts with payers and then collaborate with them? Well, the folks at the GEDC and West Health have thought about this and have put together a handy three-step approach:

1. Identify potential value-based care organizations (e.g., accountable care organization or ACOs, Medicare Advantage plans, Medicaid Managed Care) whose beneficiaries may be receiving care in your ED.

• • Contact representatives from your hospital or health system’s population health, utilization review, executive suite, and/or contracting teams to inquire about at-risk contracts with beneficiaries receiving care in your ED.
  • Research potential value-based care organizations within your community in order to locate potential collaborators (e.g., physician led accountable care organizations, Programs for All Inclusive Care of the Elderly (PACE), Primary Care First participants).
    • Physician group collaborators:
    • A list of the top 25 physician groups by size can be found here.
      
      In the Medicare space, given the growth in both ACOs in FFS and Medicare Advantage plans (as noted in this blog post, Medicare Advantage is reaching around 50 percent of the total Medicare population), it is important for you to particularly focus on these entities.
  • ACO collaborators:
    • A list of the top 25 ACOs by patient population can be found here.
    • A list of Medicare Shared Savings Program ACO beneficiaries with a patient visit to a GED can be found here.
  • Medicare Advantage (the private insurance option in Medicare) plan partnerships could include:
    • A list of the top Medicare Advantage plans by state can be found here.

• • Other top MA plans include:

2. Collaborate with representatives from your hospital or health care system to contact local value-based care organizations, such as an ACO or Medicare Advantage plan your system already has contracts with, in order to develop collaborative partnerships.
   
   The first steps you will need to take to develop a successful partnership are:

• • Try to identify patients in the ED who are part of value-based care initiatives: It is important to inventory how your ED and value-based care partner currently share patient information. A recognized pain point is that value-based care organizations are often not aware in real time when a beneficiary is in the ED. Similarly, ED teams do not know when they are treating a patient in a risk-based arrangement with access to extra resources.
  • Enable and incentivize real-time communication: Collaborative communication protocols, such as an alert mechanism, expedited phone/text messaging, or integrated features within a hospital’s electronic health record, are key to creating patient safety and durable dispositions.

3. Launch ongoing quality improvement projects with your value-based care organization partner around shared metrics.

Some ideas for collaborative projects with your value-based partners could include:

• • Creating a care management connection for rapid access to outpatient medical and home-based services
  • Primary care and specialty follow-up
  • Medication management
  • Physical therapy consultations

To sum it up, you should approach value-based care organizations with a consultative partnership in mind in order to identify the needs of your local community and address pertinent quality and cost metrics that can improve care for the targeted patient population.

We also want to reiterate the important role that GEDs can play in this transition to value-based care. As GED accreditation continues to grow, the amount of value-based care beneficiaries receiving care in a GED is also growing.

GEDs are already collaborating with their value-based care partners. A primary example is St Joseph’s Health GED in New Jersey, one of the country’s first Level 1 Geriatric EDs, and St. Joseph’s physician-led clinically integrated network, Health Partners. Another example is Advocate Aurora Health, committed to transitioning all 26 of their EDs in Wisconsin and Illinois into GEDs by partnering with the three ACOs in their health system. In both these cases, the GEDs’ leaders connected with their population health teams and value-based partners to forge strategic collaborations to make the ED experience higher quality and higher value for their shared patients. They are working to make sure the resources of the value-based care organizations (such as rapid follow-up care and care management) are made available when these patients seek care in the ED.

Overall, we want you to come away with a sense of optimism. You can be the frontrunners in this transition to value-based care! You can take the initiative and follow the steps outlined above. And if you need help, you can reach out to us! Together, we can move towards a better and more efficient care delivery system!

Before concluding, I want to give you a preview of what we’ll focus on in the remaining blogs in this series. In our next blog, we will discuss some potential ways to engage in value-based care outside the four walls of the ED, including describing some treatment modalities, such as telehealth, that have been utilized, and some initiatives that have already been tested. Finally, we may write one additional blog that will wrap up all that we’ve discussed and assess the future landscape for value-based care in emergency medicine.

We hope to publish the remaining blogs in the blog series over the next several months. In the meantime, rest assured, you will still get your weekly filling of regs and eggs on other regulatory issues affecting you and your patients!

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!