The need for innovation in emergency medicine (EM) has never been greater.
The pandemic has strained physical and emotional resources and exposed the fragility of volume-based, fee-for-service reimbursement. Payers and legislators are pushing back on rising health care costs with decreasing reimbursement and new payment models. Patients and society are demanding value, outcomes, and convenience, necessitating our profession to evolve into new clinical and administrative roles. That’s why US Acute Care Solutions (USACS) formed an innovation team, including two Innovation Fellows, who are the authors of this article. USACS is a physician-owned clinical practice group that provides patient care at more than 300 facilities in EM, hospital medicine, critical care, obstetrics, observation medicine, and post-acute care.
Innovation is difficult, especially for large, established companies that might have a lot to lose on new endeavors. The Innovator’s Dilemma by Clay Christensen is a classic business book that describes how successful companies can do what seems right, but still fail in the long run as new, radically innovative competitors rise. According to Christensen, there are two types of innovation: sustaining and disruptive. Think of sustaining innovations as making incremental improvements to existing products or services (eg, a flip phone with a better battery, faster CT scanners, or video laryngoscopy intubation). In comparison, disruptive innovations fundamentally change the product or business model (eg, iPhones replacing flip phones, or telehealth challenging the notion of EM existing within the four walls of a hospital-based emergency department). Christensen points out that disruptive innovations rarely come from established companies because they struggle to make high-risk investments into uncertain innovations. Companies feel comfortable sticking to what they do well and hoping that it takes a long time before disruptive competitors take over.
At USACS, our mission is to care for patients by being national leaders in EM and acute care. In order to achieve that, we must pursue sustaining and disruptive innovation. Our innovation team includes ED physicians with extensive research experience, data scientists, and now two Innovation Fellows. We have access to data from over 7 million patient encounters per year, our senior leaders at USACS, as well as over 3,500 practicing clinicians.
As the fellows on the innovation team, we are leading projects to improve the quality and value of care. For example, USACS discovered that opioid prescription rates varied greatly between clinicians and sites. Working with our data analytics team, we developed a dashboard to show clinicians their opioid prescription rates compared to their peers. Outliers in prescribing were contacted by USACS’ Chief Medical Officer team. This program led to a 19% relative reduction in opioid prescribing which has been sustained since program implementation two years ago. The next step in this project is to increase the use of medication-assisted treatment (MAT) for opioid use disorder by increasing buprenorphine prescriptions and promoting local MAT champions. These programs will have a positive impact on minimizing the risk of our patients developing opioid use disorder.
The Innovation Team at USACS also leads metric and intervention development to respond to increased pressure from payers on ED clinicians to justify the costs of care. As Porter and Lee point out, health care organizations will need to focus on creating value for patients to survive as payers focus on costs.1 Our leadership at USACS understands that there is often wide variability in care. Two patients could have completely different emergency care experiences, even with the same complaints and risk factors. Coupled with USACS’ evidence-based clinical management tools, we are developing an admission intensity measure that will help clinicians assess and safely disposition patients in a cost-effective manner. We are also working with the state of Maryland to develop bundled payments, which sets a price for a specific clinical presentation over a set number of days along with quality targets. These types of reimbursement models are growing in health care, so we want to be part of their development and learn how to deliver good quality, cost-effective care in new reimbursement models.
Emergency medicine continues to change. Patients deserve higher value care that optimizes the ratio of quality to cost and solves the reason they came to us. We want to be part of the solution by defining how our specialty will respond to those needs. For new ideas to succeed, we at USACS, and EM as a whole, need to create space to try new ideas. This innovation fellowship allows us to play in that space on a national scale to ensure that physicians like us take charge of the future of healthcare.
- Porter ME, Lee TH. Why strategy matters now. N Engl J Med. 2015;372(18):1681-1684. doi:10.1056/NEJMp1502419