The complexity of caring for older adult patients in the emergency room can be challenging when disposition options are limited to admission, discharge or observation. Advanced care options and wraparound services may be needed to address the issues presented and improve long-term health outcomes. Those resources simply aren’t easily accessible from the ED. However, Value-Based Care Organization (VBCO) partnerships represent an opportunity to expand disposition options to better meet the needs of patients who need follow-up and support services to achieve desired health outcomes. With these partnerships, Geriatric Emergency Departments (GEDs) can connect clinical operations to outpatient resources available through the VBCOs. Such a resource alignment between organizations with complementary missions can benefit patient experience, quality of care, and save costs.
More robust options to satisfy these complex situations are critical since the ED accounts for nearly 60 percent of hospital admissions for older adults at an average minimum cost of $14,900. This cost to Medicare for admissions and, in some cases, readmissions, not to mention the harm to beneficiaries, simply isn’t sustainable. The projected deficit between 2028 and 2031 totals $247 billion. To offset the financial toll and to improve the long-term health outcomes for patients, the Center for Medicare and Medicaid Services (CMMS) set a goal to see 100 percent of Medicare beneficiaries in a value-based care arrangement by 2030.
Strategically, most GEDs are already focused on improved patient experience and cost-conserving measures. Establishing a partnership with VBCOs aligns with those goals and initiatives and will become more of an imperative as CMS drives adherence to their value-based care goals. In order to facilitate this process, the West Health Institutedesigned a toolkit, Forging Aligned Partnerships Between Value Based Care Organizations & Geriatric Emergency Departments: A Toolkit for Geriatric Emergency Departments, that equips clinical and operational leaders with comprehensive guidance, applicable data and templates to initiate and develop partnerships.
VBCOs give GED physicians more choices and resources to address their patients’ needs to better suit their circumstances and improve their long-term health outcomes. That might include acute care at home, various therapies or support resources. GEDs are often treating VBCO beneficiaries, but many GED physicians may not know how to access VBCO resources on their patient’s behalf. Beyond expanding the scope of disposition options, partnerships with VBCOs offer additional benefits:
- Lower costs
- Reduce hospitalizations
- Improve care quality
- Improve the patient experience
- Reduce unnecessary or redundant treatment
- Improve care coordination
The framework for establishing these partnerships relies on two key building blocks: bi-directional education and a care management connection. The toolkit provides the steps to create this educational foundation and institute modes of communication between your GED and local VBCO. An appendix includes practical tools including an action checklist, instructions on how to determine the degree to which VBC beneficiaries are receiving care in your GED and resources for conducting outreach and facilitating conversations. Change and establishing new programs will inevitably be met with barriers, and the toolkit thoughtfully addresses objections and concerns that might arise.
With looming Medicare insolvency attributed to rising healthcare costs, GEDs and VBCOs are both highly motivated to pursue care structures that lower costs. Both also share a commitment to delivering quality care that achieves a satisfactory patient experience and results in positive health outcomes for older adults. These complementary aims support integrated partnerships and coordinated care connections that benefit all parties.
By downloading West Health Institute’s Forging Aligned Partnerships Between Value Based Care Organizations & Geriatric Emergency Departments: A Toolkit for Geriatric Emergency Departments, clinical and operational leaders can more deeply understand the alignment between GEDs and VBCOs and initiate the connections that begin to build the care network. At the core of the toolkit is the vision of a more comprehensive care landscape for older adults that blends clinical care with outpatient support to realize more sustainable positive outcomes for more patients.
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.
