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Acute Medical Care: Navigating a Complex System

Author: Brendan G. Carr, MD MS, Director, Emergency Care Coordination Center; Tara Holland, MPH, CHES Sr. Management Analyst, GAP Solutions, Inc. - Supporting the mission of: Emergency Care Coordination Center (ECCC); and Jessica Oidtman, ScM – Policy Analyst, Division of Health System Policy
Published Date: 10/21/2016 10:28:00 AM
Category: Public Health Preparedness;

Imagine you are on vacation. Your son slips, falls and is unable to walk on his injured leg. Should you go to the emergency department? Or would a retail clinic or urgent care center be better? And would that place have the X-ray machine or other capabilities necessary to care for your son?

Many factors influence when and why people choose to seek care. This is especially true for acute care – like your son’s injured leg – that is often time-sensitive and unscheduled. Some of these factors are personal, like the severity of an individual’s specific health condition; where they prefer to get care; how easy it is for them to get to the places where and when care is available; and what support they have from family and friends. Other factors are related to the communities where people live, like what options are available for care; the quality of that care; and how easy it is to get the other things people need to stay healthy, like housing, food, and support from their community.

Options for acute care in the U.S. are complex, even bewildering. For instance, acute care delivery occurs in many settings, including emergency departments, urgent care centers, retail clinics, doctors’ offices, and by telemedicine. The services and capabilities of these facilities may vary dramatically. People often need help navigating this complex system to choose the best place to go for the care they need and sometimes they need to do it quickly or in an unfamiliar location. Helping people navigate the increasingly complex system is critical.

So, how can we help your injured son get the care he needs after he has fallen on vacation?

The U.S. Department of Health and Human Services (HHS) has recognized that we need a more integrated and patient-centered way to deliver care during our most vulnerable of moments. HHS’s delivery system reform initiatives seek to ensure that the health care system delivers better care, spends health care dollars more wisely and results in healthier people. The Affordable Care Act created a number of new payment models that move the needle even further toward rewarding quality. Providers have a financial incentive to coordinate care for their patients and reduce duplicative or unnecessary x-rays, screenings and tests. This patient-centric approach can and should be extended to the acute care setting.

Accordingly, the ECCC contracted with the George Washington University to develop a Conceptual Model for Management of Acute Unscheduled Care in the U.S. The model helps to disentangle the complex acute care system by describing the options and factors that influence people’s decisions about where, when, and how to receive medical care during their time of need. The model begins with the social and individual determinants of health that influence the likelihood of acute illness and injury, then describes care-seeking decisions, care delivery settings, transitions in care, and how quality care leads to differences in health outcomes and costs.

This conceptual model is the first step in helping people navigate the increasingly complex acute care system. The model addresses the multitude of issues facing the day-to-day healthcare system, and has implications for disaster and public health emergencies that create increased demand.

The full report highlights that the management of acute illnesses, injuries, and exacerbations of chronic conditions is multifaceted and involves many stakeholders (e.g., patients, providers, payers, and policymakers) from across the healthcare system.

HHS will soon announce the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule. Hundreds of thousands of Medicare providers across the country will be asked to choose their own path of participation in the Quality Payment Program – focused on moving the payment system to reward patient-centered care. As we shift to a system of care that rewards health care providers for providing quality care, it is critical to consider the acute care experience through similar lens and reward care coordination that result in better health.


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