b'COVID as a CatalystIn June of 2020, I and two of my colleagues at SCP Health (SCP)presented a webinar titled COVID-19 as a Catalyst: Rebuilding theHouse While Preparing for the Future. 2The theme was drawn in part fromHenry Kissingers famous quote: The historic challenge for leaders is tomanage the crisis while building for the future.Whether we wanted it or not, 2020 was a year that forced clinicians and health care leaders at nearly every level to do as Kissinger suggested. We faced a crisis unprecedented in our lifetime. Across all our sites, patient volume in emergency departments declined by 50 percent within six weeks. Ambulatory patients virtually disappeared overnightbeginning on March 13, the day a national emergency was declared due to COVID-19. Our core prediction was that COVID-19 would catalyze much-needed solutions that had good reasons to progress, but previously languished without regulatory and legislative solutions or without the support of an aligned payment model. That prediction has thus far turned out to be correct. We highlighted five such trends:1. Growing use of telemedicine2. Transition of volume to urgent care3. Increasing utilization of non-physician resources4. Payment changes supporting additional models of care5. Increasing focus on social determinants of healthAll five of these COVID-accelerated trends support cost-effective solutions that can be utilized by emergency departments, inside and outside the four walls of the ED. None of these trends obviate the core requirement forhigh-quality emergency care. But all of these trends are required to address Care in the Gap, which I will discuss later in this paper.2.The Turning Point & Evolutionof the EDs Vantage PointIn 1986, Congress made a fateful decision to clamp down on a practice known as patient dumping. Hospital emergency departments were denying care to patients with a medical need but insufficient means of payment, and dumping them to a different hospital, making them someone elses economic problem. Truly, this was abhorrent. The law passed in response to this practice was named the Emergency Medical Treatment and Active Labor Act, now known ubiquitously as EMTALA.The immediate consequence was that hospitals could no longer shift patients who needed care somewhere else. The law created a legal responsibility to see, assess, and stabilize these patients within the capabilities of that institution. This much is well understood. Yet the long-term consequences of EMTALA are still not fully appreciated.Together, we healTogether, we heal 4Together, we heal SCP HEALTHIFROM INSIGHTS TO INTERVENTIONS'