recent study found that older people with Alzheimer’s disease and related dementias visit the emergency department (ED) at twice the rate of their peers, an outcome that researchers characterized as “potentially avoidable and harmful.”

Upon arrival at the ED, adults with dementia were likelier to receive unnecessary tests along with medications that pose long-term health risks such as antipsychotics and sedatives. To receive this low-value care, typically from clinicians they don’t know, seniors and their families often must contend with lengthy waits in an unfamiliar and confusing environment — a recipe for a bad patient experience.

This study represents just a snapshot of a fundamental problem in our healthcare system, affecting not only those with dementia, but millions of aging adults with other chronic and disabling conditions. Care is driven by facilities rather than the needs of patients, leading to poorer health outcomes, higher costs and worse care experiences.

Although older patients with chronic conditions or behavioral health needs, particularly those who are dually eligible for Medicare and Medicaid, generally require the most healthcare, they also experience the greatest barriers to receiving it. All too often the emergency department becomes the default when someone lacks transportation or faces another barrier that prevents them from getting to an urgent care clinic or doctor’s office. As we know through the dementia study, it’s more likely that the clinicians in the ED will not have a full picture of the medical, social, and behavioral health needs of their patient — fragmentation that can cause further issues down the road.

Payer/provider organizations, also known as “payviders,” are in a unique position to address this issue because they are fully responsible for the cost of patient care. They are incentivized to shift focus out of the emergency department, and into the home and community — places where people are ultimately better served.

One way this can be achieved is by utilizing mobile integrated health and community paramedicine (MIH-CP). MIH-CP programs like instED, created by Commonwealth Care Alliance in 2018, help people avoid an emergency room or hospital admission by providing urgent medical care in patients’ homes, on demand, using highly trained paramedics in coordination with primary care providers. Last year, instED helped 86% of its users to avoid an unnecessary visit to the hospital.

While most healthcare organizations are not “payviders,” insurers and providers can and should explore collaborations that facilitate the kinds of programs that lessen our reliance on the ED. Alternative payment models such as bundled or full-risk payments, allow for preventive services, care coordination, and home-based interventions that are not viable within the confines of traditional fee-for-service. In addition to MIH-CP, this allows for investment into things that help keep older adults with chronic conditions out of the hospital. Nutritious meals, home modifications, behavioral health supports, and personal care attendants are a few examples.

As health systems and insurers prepare to serve an aging population on the rise, we must remain open to innovation and flexibility that displaces the ED as our instinctive first point of care. People living with dementia, expected to nearly triple worldwide by 2050, and many others will benefit when we finally begin to deliver better, more patient-friendly care – when and where people want and need it.

Chris Palmieri is president and CEO of Commonwealth Care Alliance.