Seamless care transitions is a major priority for health systems. Population-based payment reforms implemented in Maryland (MD), termed the global budget revenue (GBR) program, has incentivized a shift towards non-hospital care and lower admissions. ED-based care coordination can have an important role in meeting these goals. We examine ED care coordination processes across MD and identify specific interventions. We also examine perceptions on the effectiveness of care coordination and the influence of GBR. We conducted a qualitative study using semi-structured interviews to examine ED care coordination processes, initiatives, and perceptions among emergency physician leadership and care coordination staff (CCS). Participants were purposively recruited across MD EDs to ensure diverse representation of EDs in annual volume (range: 12,000-90,000), system affiliation, trauma level, and metropolitan status. A total of 21 semi-structured interviews encompassing 15 different sites were conducted, with an interdisciplinary group representative of the ED care coordination process: physician leadership (n=14) and CCS (n=7). Interview questions covered domains pertaining to different facets of the care coordination process as well as perceptions of the influence of GBR. Participants’ answers were coded independently using thematic analysis by two members of the research team, with coding disagreements assessed and resolved by the full research team. Across all sites, there was an average of 4.3 full time equivalents (FTEs) of CCS coverage with significant variation (range: 1 - 12 FTEs). The most common care coordination services provided were implementing care plans for high utilizers and arranging outpatient substance abuse services, home health services, and home medical equipment. The number of initiatives implemented to improve ED care coordination ranged from 0 to 7 initiatives per site. The most common initiative was a process to link substance abuse patients with peer counselors and rehabilitation resources (9 sites). Participants perceived ED care coordination as effective in facilitating safer discharges and addressing social determinants of health; however, adequate access to outpatient providers was a significant barrier. (Table 1) The majority of emergency physician leaders (9/14) perceived GBR as having a mixed impact, both positive and negative, on care transitions. The majority noted that ED “care coordination is a beneficial offshoot of GBR...now hospitals are motivated to put money into [care coordination] resources.” However, participants also noted that with GBR “we are working extra hard for extra long to not admit patients” and “GBR has negatively impacted ED length of stay.” Across MD, there is a broad range of ED care coordination services provided and significant variation in the organizational processes to implement them. However, a prevailing theme is that GBR has led to investments to improve ED care coordination. Further research is needed to examine the association of the various approaches to ED care coordination with patient outcomes.