b'The Impact on PayorsIn the course of my work with health plans, I often hear complaints about avoidable costs, Low-acuity visits:perceived or otherwise. I hear frequently about potentially avoidable low-acuity ED visits.But I hear far less frequently about more impacting issues. 1% of annualpatient volumeSCPs internal data repeatedly shows that low-acuity visits usually comprise less than 0.2% of annual cost 1% of an emergency departments annual patient volume, and less than 0.2% of itsannual cost. Conversely, the moderately complex conditions noted in Figure A comprise35% of the annual volume, over 40% of the annual cost, and contribute to a vast majorityof repeat ED visits and subsequent hospitalizations.Moderatelycomplex visits:Focusing on higher complexity visits offers exponentially more opportunity. These are 35% of annualthe patients that are higher acuity, who rely on the emergency department for stabilizationof acute or chronic conditions, and require more solutions in the Gap than our current patient volumesystem provides. With solutions in the Gap, costs will decrease, satisfaction increases, and 40% of annual costoutcomes improve.Most of these solutions need to be in the immediate post-acute period(after an initial ED visit).Health plans (both commercial and governmental) are important partners when it comes to addressing the challenge of Care in the Gap. In An All-Payer View of Hospital Discharge to Post-Acute Care, Dr. Wen Tian used the 2013 National Inpatient Sample to estimate the percentage and share of costs for the nearly 8 million patients discharged to post-acute care settings each year. These 8 million patients account for 22.3 percent of all hospital discharges.Not surprisingly, a huge proportion of patients (approximately three quarters) discharged to post-acute care settings are Medicare beneficiaries. The proportion is higher for SNFs (84.9%) and long-term care hospitals (76.2%) and somewhat lower for inpatient rehabilitation facilities (68.7%) and home health agencies (64.6%). 9But how hospitals and health systems choose where to discharge, and what coordination is provided, if any, remains opaque and unconnected to patient outcomes. Dr. Tian wrote: Discharges to PAC often are driven by the availability of specific types of settings and by financial incentives that are not always aligned with clinical needs and may not be cost-effective.And, in a telling passage from the Deloitte report, its authors note the ambivalence of health plans about what happens post-discharge. Most health plans we spoke with believe that their medical management approaches are reasonably effective at controlling costs and quality for their Medicare Advantage populations and any further responsibility for improving post-acute care cost and quality falls to health systems. However: Other health plans take a more active role in post-acute care performance by developing new clinical models and analytically-driven decision-making tools. 10Health plans that take a more active role and provide solutions for Care in the Gap will see increased member satisfaction, realize a competitive advantage by empowering their members to do well, and will excel in a world increasingly impacted by value-based models of care.The Impact on CliniciansI wrote extensively on the implications of the Care Gap for clinicians in From Insights to Interventions.First, taking responsibility for what happens after a patient leaves our care is highly consistent with a patient-centered mission. In the emergency department, our core mission is to treat the sick and injured regardless of the patients race, class, gender, or ability to pay. The ED is the nations clinical safety net, and it is natural to embrace the fact that this also includes what happens to patients after they leave our care.Second, by addressing the Care Gap we reduce unnecessary or avoidable visits. This impacts key elements of cost during a time of severe stress on ED and hospital capacity, where reducing avoidable visits can have a material effect on the ability of clinicians to focus on what is absolutely necessary. Ultimately, no emergency physician enters the specialty with a mission of caring for patients who dont really need to be there. By expanding our attention to the Care Gap, we support clinicians in working at the top of their license, and optimize the impact of first-contact care.Together, we healTogether, we heal 5Together, we heal SCP HEALTHITHE GAP: WHY WE SHOULD CARE'