Telehealth Emergency Department Transition-of-care Program: A Value-based Innovation

Introduction: Our Emergency Department (ED) and Population Health Services Organization developed a telehealth ED-transition of care program (TOC) for patients insured through value-based contracts. This study’s goal was to determine the association of our ED-TOC on ED revisits. We hypothesized that the ED-TOC would decrease ED revisits.Methods: This was a retrospective cohort study conducted between August 1, 2021 and July 31, 2023 at two EDs where an ED-TOC is available. Included were ED visits among discharged Medicare beneficiaries that occurred one year before and after the launch of the ED-TOC program.  ED visits involving Medicaid beneficiaries served as the control.  A difference-in-differences (DID) strategy was used to compare Medicare and Medicaid visits. The primary outcome measure was the association of the program with 14- and 30- day ED revisit rates. Secondary outcomes were the association of the ED-TOC with post-discharge PCP visits and hospitalizations and estimated cost-savings associated with the program.Results: Our sample size was 23,696 ED encounters (13,553 treatment group and 10,143 control group).  At 14-days after ED discharge, Medicare beneficiaries were associated with a 1.77% decrease in the rate of ED revisits in the year after the ED-TOC launch relative to the control (p=0.03) or a 15.8% reduction relative to baseline (11.2% to 9.4%).  At 14-days after ED discharge, PCP visits were associated with a 1.51% increase in the year after program launch relative to the control (p=0.03) or a 10.3% increase relative to baseline (14.6% to 16.1%).  No difference was associated with Medicare beneficiaries’ ED revisits or hospitalizations at 30-days. PCP visits were associated with a significant increase at 30-days (p=0.005).Conclusion: An ED-TOC is associated with a reduction in Medicare ED revisits during days 8-14 after an index ED visit but not during days 1-7 days or at 30-days.   Cost savings over a 24-week period are conservatively calculated to be $215,779.