• Sofie Rahman Morgan, Meaghan A Smith, Stephen R Pitts, Robert Shesser, Lori Uscher-Pines, Michael J Ward, and Jesse M Pines.
• Department of Emergency Medicine, Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA. sofie.r.morgan@emory.edu
• Am J Manag Care. 2012 Sep 1; 18 (9): e356-63.

AbstractIncreasing healthcare costs have created an emphasis on improving value, defined as how invested time, money, and resources improve health. The role of emergency departments (EDs) within value-driven health systems is still undetermined. Often questioned is the value of an ED visit for conditions that could be reasonably treated elsewhere such as office-based, urgent, and retail clinics. This paper presents a conceptual approach to assess the value of these low-acuity visits. It adapts an existing analytic model to highlight specific factors that impact key stakeholders' (patients, insurers, and society) assessments of the value of ED-based care compared with care in alternative settings. These factors are presented in 3 equations, 1 for each stakeholder, emphasizing how tangible and intangible benefits of care weigh against direct and indirect costs and how each perspective influences value. Aligning value among groups could allow stakeholders to influence each other and could guide rational change in the delivery of acute medical care for low-acuity conditions.

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