A new toolkit from the West Health Institute aims to equip clinical and operational leaders with the tools to partner with local value-based care organizations (VBCOs) in order to provide additional dispositions for older adults. Traditional paths of admission, discharge, or observation limit the scope of disposition choices to those that may not be optimal to address the patient’s acute needs and goals of care. Without viable alternatives, patients and healthcare systems face unnecessary admissions or avoidable readmissions at a cost of $17 billion annually to Medicare. In fact, 60 percent of older adults admitted to hospital enter through the emergency department.
Partnerships between GEDs and VBCOs can create coordination and planning strategies that focus on improving the patient experience and achieving a positive long-term outcome that circumvents unneeded hospital admissions. Partnerships have the potential to lower costs, reduce hospitalizations, elevate care quality and improve patient experience. Forging Aligned Partnerships Between Value Based Care Organizations & Geriatric Emergency Departments: A Toolkit for Geriatric Emergency Departments provides a comprehensive roadmap for understanding and implementing this work.
“This toolkit was developed to foster strong care connections between GEDs and VBCOs serving the older adult population that share a vision of high quality and low cost care,” said Amy Stuck, Senior Director, Value-based Acute Care at West Health. “Our goal with this detailed, practical resource is to ensure that older adults avoid unnecessary admissions, thereby helping older adults age successfully while lowering the total cost of care.”
GEDs with VBCO partnerships have a broader spectrum of resources available to address patient needs outside of the emergency room. In-home nurse practitioner visits, same day specialist appointments and Community Paramedic check-ins represent examples of services that VBCOs can offer to better serve patients whose circumstances may not indicate admission but demonstrate a need for a higher level of care.
The toolkit provides a detailed overview of the value-based care landscape and resources to help interdisciplinary clinicians identify the VBCOs serving their area. A thorough appendix includes communication templates, meeting agendas and plan components to help administrators conduct the necessary outreach and drive collaboration on a plan that integrates VBCO resources into treatment protocols.
Organizations that pursue these partnerships will result in a more appropriate set of disposition options for an aging population. Since 2010, the 65+ population surged by 34.2 percent. As that number continues to grow, this toolkit will support providers in designing the types of alternative dispositions and connecting patients to available additional services that older adults deserve.
To forge aligned partnerships between VBCOs and GEDs, West Health Institute brought together three dyads in August 2023, charged with reducing inpatient visits originating from GEDs, among other aims. The VBCO-GED dyad partnerships and their improvement initiatives were as follows:
- Cleveland Clinic ACO & Cleveland Clinic Main Campus Level 1 GED: Integrate a new ACO program, “Home Care+”, that offers comprehensive, at-home, wrap-around services into GED disposition options.
- Integra Community Care Network & Care New England’s Kent Hospital Level 2 GED: Embed a new Integra nurse into the GED to identify Integra members and collaborate with ED clinicians to disposition Integra members to Integra’s home and community-based programs.
- UNC Health Alliance & UNC Hillsborough Level 2 GED: Connect rapid, out-patient, specialty care services into GED disposition options.
Overall, dyad partners averted 508 admissions, equating to $6,440,348.00 – $7,274,810.00 in gross service savings from September 30, 2023 to September 30, 2024.
