b'Alternative Vantage Points The ED has both a unique perspective - hard to come by - and an opportunity for important change. Still, other parts of the health care system also have unique perspectives. Like those in the ED, others may feel a desire and responsibility to extend their role to meet our collective challenges. These perspectives are worth examining:PayorsIf there is one constituency in health care with obvious incentives to reduce costs, it is payors, including both governmental and commercial health plans. Payors have a hybrid relationship with clinical providers: at timesantagonistic, using their market power to reduce reimbursement rates or seeking to deny coverage; and at othertimes a partner in alternative payment systems, seeking to transition a portion of risk and reimbursement tovalue-based payment systems.Payors should be a leading contender, aside from emergency departments, for an expanded role in addressingthe challenges of care coordination and care delivery discussed above. Yet payors are also at a severedisadvantage in at least three respects: Payors do not see patients. While payors may purport to have visibility into and insight about the health of their customers, there is only so much a coded chart and a request for reimbursementcan tell you about the true challenges facing patients. Payors are not the patients doctor. They do notsee patients, and while many individuals who work for payors are highly skilled and knowledgeable(and some are physicians themselves), their role is substantially different than that of a patientsclinician.Payors lack trust. Patients generally want to hear from their insurance company only when they will be paying for all or a substantial part of their health care costs. A payors primary interaction with theirmembers are usually transactional and revolve around payment and the structure of their benefits. Payors do not see the uninsured. Whereas emergency departments have an EMTALA-driven requirement to see everyone, those who are uninsured are not the payors concern. In the emergencydepartment, the uninsured population ranges widely, but is typically 25-35% of all patients. 6Primary care physiciansPrimary care physicians (PCPs) are the oft-mentioned missing link in American health care. For more than adecade, leading voices in the health care industry have pointed to primary care as the solution to the challengesof uncoordinated care, access to care, and some aspects of care delivery.The problem with turning to primary care is that there remains a long-standing lack of access (or timely access)a challenge no one has solved despite many, many efforts. Market forces, lower pay than otherspecialties, and downward reimbursement pressures all contributeand, unlike emergency care, there is noEMTALA analog (no requirement to deliver timely access on demand).Additionally, like payors, PCPs have limited visibility into those patients who lack health insurance, as well as those who, for whatever reason, will only seek health care in acute unscheduled situations. These are crucialdeficits when it comes to addressing the challenges of rising costs, unnecessary hospital admissions, and chroniccare for target patient populations.Together, we healTogether, we heal 475Together, we heal SCP HEALTHIFROM INSIGHTS TO INTERVENTIONS'