b'The Gap: Why We Should CareThe opportunity and the imperative for hospitals and health systemsTOGETHER, WE HEALIVolume 1, Issue 2 scp-health.comBy Randy Pilgrim, MD, FACEP, FAAFPIntroductionThe Emergency Department sits at the nexus of hospital-based care and the outpatient world. It continues to serve as a front door for the hospital, but it also occupies a vantage point that provides unique insights into the health of the surrounding community. From this vantage point, we can see clearly an unaddressed Care Gap that is costing the health care system dearly. The Gap produces worse outcomes for patients despite higher costs, loss of market share for hospitals, and suboptimal performance in value-based plans.The negative effects of this Care Gap impact payors, employers, clinicians, and patients. Each of these groups has a stake in seeing that the Care Gap is addressed.Last year, SCP Health identified and described this Care Gap in a white paper,From Insights to Interventions: Using the unique vantage point of the emergency department to drive transformation. This paper identified significant populations regularly receiving care in our nations emergency departments that require transformative approaches. Shortly, I will lay out in greater detail how we in health care can do a better job of predicting the Gap, closing the Gap, and delivering care and coordination to the patients most at risk in the Gap.In this series, entitled Together, We Heal, we will cover: Predicting high risk patients: how to predict which patients are likely to fall through the Gap, leading to avoidable ED visits,re-hospitalizations, and higher costs for employers and patients Post-discharge transitions: best practices for optimizing outcomes after discharge from the ED Clinical interventions: strategies for post-discharge touchpoints, including bridges to primary care, behavioral health,telehealth, and home care solutions Non-clinical interventions: wayfinding and practical instruction for patients on appointment setting, filling prescriptions, andadherence to treatment plansHealth equity: the role of health equity before, during, and after the Gap, and how differences can affect outcomesBy addressing these topics and more, clinical and operational health care leaders can begin to overcome critical shortcomings in our health system and prepare for further transformation. This is a time of fast-paced change, with stressors all around. These recent difficult years have shown that we can band together in time of crisisbut innovation and change are necessary if we are to build (and lead) a functioning system that is sustainable into the future.Together, we healTogether, we heal 1Together, we heal SCP HEALTHITHE GAP: WHY WE SHOULD CARE'