NEJM Catalyst

NEJM Catalyst Practical innovations in health care delivery:

Ideas, solutions, and case studies to improve patient care and drive value in health organizations.

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery. NEJM Catalyst brings insightful articles and real-life examples from a network of top thought leaders, experts and advisors to provide:

Practical innovations in health care delivery;

Impeccable quality and impact;

Active contributions from renowned authorities, thought-leaders, and advisors;

Independent and impartial curation; and

An exchange of ideas among executives and clinicians. NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.

For patients with cancer who experience treatment-related symptoms, emergency department visits to manage symptoms may o...
01/23/2026

For patients with cancer who experience treatment-related symptoms, emergency department visits to manage symptoms may occur frequently, contributing to long wait times, unplanned hospital admissions, and possible interruptions in cancer treatment.

Studies estimate that 20%–60% of ED visits among patients receiving cancer treatment could be managed outside the ED or hospital setting. Oncology urgent care clinics, created to manage nonemergent conditions in an outpatient setting, are an increasingly recognized solution.

The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center (SCCC) consistently noted difficulty accommodating same-day appointments for patients experiencing acute symptoms, often leading to ED referrals. In response, SCCC developed a same-day appointment option for patients experiencing acute medical concerns: Simmons Acute Care (SAC). The goal was to address nonemergent acute issues, thereby reducing avoidable ED visits and improving the quality of care.

A pilot study was implemented to evaluate the feasibility and identify the challenges for SCCC patients who were receiving any cancer treatment modality, or who had completed treatment within the past 90 days.

Nine clinical pathways were developed to provide evidence-based care. A fast-track laboratory courier system and expedited imaging were incorporated into the process model. A dashboard to identify clinical outcomes, process measures, and trends was created to track real-time data and provide monthly updates to core staff. The dashboard tracked key metrics while maintaining engagement and identifying needs for additional resources.

Notably, current data reflect that 75%–80% of SAC encounters are seen and discharged home with a next-day follow-up call by a registered nurse. Approximately 15% of the SAC encounters are directly admitted to the hospital, bypassing the ED. These data reflect a response to the evolving complexity of cancer care and patient care needs by offering a rapid connection to an experienced care team. SAC is now the standard pathway for oncology patients who meet the criteria.

Read the article: https://nej.md/3LNRaq4

Emergency department crowding, constrained inpatient capacity, and long waits for outpatient cardiology delay care for p...
01/22/2026

Emergency department crowding, constrained inpatient capacity, and long waits for outpatient cardiology delay care for patients with urgent cardiac symptoms.

In 2016, the Beth Israel Deaconess Medical Center opened a non–ED-based, cardiologist-staffed Cardiac Direct Access Clinic with examination rooms, an infusion room, and six overnight observation beds to provide rapid specialty evaluation and short-stay care.

Using administrative data and contribution-margin analyses, the authors assessed operational, clinical, and financial outcomes and summarized implementation strategies.

Of 11,121 total patients seen in the clinic, 4239 patients — those most likely to have otherwise been sent to the ED — were admitted on the same day of referral. Of those patients, 59% were discharged home, 39% were managed in the Cardiac Direct Access Clinic’s overnight unit, and 7% ultimately were admitted to inpatient floors. Among 1467 patients discharged from the overnight unit, the 30-day return rate to the ED was 6.4%. Overall patient experience scores were higher for the clinic than for the ED — 84.7 versus 56.9.

Annual labor and supply costs for the clinic totaled approximately US$1.8 million. The contribution margin derived from the clinic’s operations (US$245,000), admissions originating from the clinic (US$303,000), and inpatient capacity created (US$1.34 million) produced an estimated US$2.4 million annual contribution margin, underscoring financial sustainability.

Key enablers included centralized prior-authorization teams, state approval to operate as an alternative care space for inpatient-level services, and codified diversion pathways for the ED and urgent care.

Read the article: https://nej.md/4qSeKAQ

NEJM Catalyst Insights Council members express strong personal commitment to addressing social determinants of health (S...
01/22/2026

NEJM Catalyst Insights Council members express strong personal commitment to addressing social determinants of health (SDOH) and also identify many challenges: lack of resources, poor coordination with community partners, and insufficient reimbursements to support SDOH programs. Read the full report: https://nej.md/45g4ES9

The February issue of NEJM Catalyst Innovations in Care Delivery includes commentaries, articles, case studies, and rese...
01/21/2026

The February issue of NEJM Catalyst Innovations in Care Delivery includes commentaries, articles, case studies, and research reports on community pharmacists, health care consumerism, prior authorization, value-based care, social determinants of health, a cardiology clinic, oncology urgent care, and vitamin D testing. Read or listen to the letter from our editors: https://nej.md/4pOdRZh

📢 Our February 2026 issue is live! In the issue: community pharmacists, health care consumerism, prior authorization, va...
01/21/2026

📢 Our February 2026 issue is live! In the issue: community pharmacists, health care consumerism, prior authorization, value-based care, social determinants of health, cardiology clinic, oncology urgent care, vitamin D testing

📖 View the issue: https://nej.md/4sJixCf

🎧 From the Editors: Predicting the Future of Health Care https://nej.md/4pOdRZh

👪 Insights Report: Addressing Patients’ Social Determinants of Health Is Important to Caregivers https://nej.md/45g4ES9

♥ In Depth: The Cardiac Direct Access Clinic: Improving Urgent Access while Reducing Unnecessary Emergency Department and Inpatient Utilization https://nej.md/4qSeKAQ

🏥 Case Study: A Guide to Establishing an Oncology Urgent Care Clinic https://nej.md/3LNRaq4

💊 Case Study: Curbing Unnecessary Vitamin D Testing https://nej.md/4pHZ0iY

🌎 Article: Scaling Value-Based Care across the United States: Progress from Risant Health https://nej.md/4pHGDKO

💊 Commentary: Beyond the Counter: The Community Pharmacist of the Future https://nej.md/4aZpybK

📊 Commentary: The New Health Care Consumerism: A Blueprint for Health System Leaders https://nej.md/49C9ryn

✅ Commentary: Prior Authorization: Moving Toward Zero https://nej.md/4bueSBZ

Hengqin Guangdong–Macao Deep Cooperation Zone: A Test Bed for Internationalizing China’s Health Care System https://nej....
01/20/2026

Hengqin Guangdong–Macao Deep Cooperation Zone: A Test Bed for Internationalizing China’s Health Care System https://nej.md/3YBFA40

Overcoming the Medical Insurance Trilemma: Artificial Intelligence Doctor Agent for Enhanced Osteoporosis Management: ht...
01/20/2026

Overcoming the Medical Insurance Trilemma: Artificial Intelligence Doctor Agent for Enhanced Osteoporosis Management: https://nej.md/4aFvRkL

The payer-provider partnership prior approval model, aligned with patient-focused value-based care priorities, presents ...
01/16/2026

The payer-provider partnership prior approval model, aligned with patient-focused value-based care priorities, presents an opportunity to reduce variation and frustration over health care delivery decision-making: https://nej.md/4bueSBZ

The NorthStar Trauma Network: An Orthopedic Care Network across Three Health Systems https://nej.md/3MJxRyb
01/15/2026

The NorthStar Trauma Network: An Orthopedic Care Network across Three Health Systems https://nej.md/3MJxRyb

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Innovations in Health Care Delivery

Health care delivery is undergoing a major transformation around quality, cost, and access. NEJM Catalyst brings health care executives, clinician leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery.

Since December 2015, NEJM Catalyst has brought together a network of health care leaders to share insightful ideas and real-life examples of innovations in health care delivery, in the form of articles, case studies, quarterly events, and monthly surveys of our Insights Council.

NEJM Catalyst is produced by NEJM Group, a division of the Massachusetts Medical Society, located in Waltham, Massachusetts.