Emergency Department Care Transition Programs—Value-Based Care Interventions That Need System-Level Support

JAMA Network

Kevin Biese, MD, MAT; Timothy A. Lash, MBA; Maura Kennedy, MD, MPH
Full Text


This article is an important contribution to the existing literature on how to improve post-ED care and care transitions and prevent unnecessary ED revisits and hospitalizations. Future research is needed to understand this variation. A telephone call (or automated telephone call) on its own is not transformative; its importance is related to which populations are reached and what interventions are provided.

Integrating EDs into value-based care models may have a particularly profound effect on many socially disadvantaged patient populations who have frequent ED visits. If EDs are supported in and held accountable for transitioning patients to primary care clinicians and nonacute care settings after an ED visit, they can help connect these patients to the long-term managed and preventive care they need. The net result will be improved health care equity, helping patients get the care they need and avoiding repeated ED visits and hospitalizations.

Integrating EDs in value-based care contracts and providing system-level support for programs that address post-ED care transition efforts aligns incentives and ensures that EDs are a partner in the work to improve health care integration, quality, and value.

Contributing Faculty

Kevin Biese

MD, MAT ( Co-PI )

Dr. Kevin Biese serves as an Associate Professor of Emergency Medicine (EM) and Internal Medicine, Vice-Chair of Academic Affairs, and Co-Director of the Division of Geriatrics Emergency Medicine at the University of North Carolina (UNC) at Chapel Hill School of Medicine as well as a consultant with West Health. With the support of the John A. Hartford and West Health Foundations, and alongside Dr. Ula Hwang, he serves as Co-PI of the national Geriatric Emergency Department Collaborative. He is grateful to chair the first Board of Governors for the ACEP Geriatric Emergency Department Accreditation Program. His passion is for improved education and systems of care for older adults, and he has published multiple materials in both these areas.

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