Despite the ample evidence in favor of coordinated care’s impact on positive patient outcomes, many C-suite leaders see implementing care coordination services as a risky move. This often boils down to financial worries, as well as unclear understanding of the potential cost–benefit ratio. Yet as the industry moves further toward a value-based ecosystem, executives need to realize that care coordination is actually a driver of higher quality and lower cost care.
First, let's define care coordination. There are so many terms and concepts surrounding care coordination these days that it can be particularly confusing trying to figure out which we are talking about in a specific setting. Is it care management, patient engagement or something else?
Care Management: The team-based, patient-centered approach designed to assist patients and their support systems in managing medical conditions more effectively. It also encompasses those coordination activities needed to help manage chronic illness. (From Agency for Healthcare Research and Quality)
Care Coordination: The deliberate organization of patient care activities between two or more participants involved in a patient's care to facilitate the appropriate delivery of health care services. (From Agency for Healthcare Research and Quality)
So, to recap:
- Care management is the approach to mitigate a condition
- Care coordination is the organization of the activities that are part of that overall management,
- Patient engagement involves the specific actions taken to assist patients as we navigate them through the course of treatment.
Here is a basic hierarchy for how these aspects relate to each other within a system of care:
But where does "specialty" care coordination come in? General care coordination is has limited value as a standalone aspect of treatment, and may even be useless. It is likely that when providers do not completely invest in a full care coordination protocol, only certain pieces or parts of the approach such as discharge management or medication adherence are retained. However, specialty care coordination offers the execution and organization of the care management approach tailored by disease set (cancer, diabetes, CHF, stroke, COPD, asthma) or service line (cancer, neurosciences, bariatrics, behavioral health).
That said, here is a more detailed (and realistic) hierarchy of how providers should implement care coordination for the benefit of not only their patients, but the practice itself:
*This concept demonstrates how a single EHR or EMR is not enough to manage a patient’s care. Access to data from all relevant systems across the treatment spectrum is required to provide a full view of care.
**Risk can be defined as risk for readmission or risk for side effects or adverse events.
With MACRA reshaping the landscape this year, it makes sense that providers would want to focus on improvements that can help them get the most out of the new payment model. That requires digging into the nitty-gritty for each subspecialty.
It is this specialty care coordination picture that shows the C-Suite the real performance inside their service lines, where their revenue is most at risk. Downstream costs from specialties include readmission penalties, increased ED visits for patients, adverse events and ultimately the ability to deliver routine care with high quality at lower costs. When C-suite executives make decisions on the dotted line that can impact their patients for years to come, this is why they need to care about coordination.