Care Coordination Benefits Those Who Need It Most
| April 17, 2019
The healthcare system is a complex network of independent entities, including service providers, insurers, and government organizations. Patients must monitor their progress within a web of physicians, specialists, payers, and regulators without access to a centralized medical record repository. This fragmented view of their medical journey makes it difficult for patients and their providers to efficiently determine the effect of any single treatment, or to assess their overall quality of care.
In an effort to respond to increasing market pressure to transition from a traditional fee-for-service to a value-based care model, insurers are encouraging the use of care coordination teams to reduce unnecessary treatments, re-admissions, and treatment redundancies — especially in populations with chronic, complex medical concerns.
CARE COORDINATION BENEFITS
While care coordination benefits and models can differ, the core of any approach is the same: to identify patients who require more coordinated care and facilitate delivery of the necessary healthcare services sequenced in the most appropriate order, at the right time, and in the proper place.
Care coordination models leverage a trained team of care givers that cover the healthcare delivery spectrum (i.e. Registered Nurse, Social Worker, Behavioral Health) who work with the patient and primary care physician to establish a strong relationship that ensures the patient has the appropriate resources to carry out all their healthcare activities. This team becomes an extension of the primary care provider’s practice.
Though care coordination benefits extend beyond patients, its advantages originate in the positive impact made upon the patient’s health and quality of life. Some models of care coordination include a wide range of personalized services including patient advocates who intervene in instances of unnecessary or redundant treatments, consult on the most cost-effective treatment options, assist with claim resolutions, and explain plan benefits.
Care coordination yields improved health outcomes and patient experiences. Benefits include:
IMPROVED EDUCATION AND UNDERSTANDING
Patient advocates help patients navigate their journey to wellness, ensuring they understand their care, physician recommendations, prescription therapy, and possible health outcomes.
BETTER HEALTH OUTCOMES
Continuous communication with care coordinators increases patient adherence to their treatment plan, improves medication adherence, and strengthens their bond with their medical team, effectively contributing to better clinical outcomes.
GREATER COST AND TIME SAVINGS
With the care coordination team working directly with the patient’s medical team to curtail inefficiencies and redundancies in care, patients can eliminate unnecessary appointments, procedures, tests, and their associated costs.
IMPROVED SENSE OF OWNERSHIP
With a deeper, clearer understanding of treatment options and expectations, and the continuous touch points care coordination provides, patients feel more empowered and actively engaged in their treatment.
Employers with self-funded plans are partnering with insurance companies that provide care coordinators to maintain healthier, more productive work forces. A well-defined care coordination program reduces costs by addressing employee health concerns before they incur significant medical expenses. Benefits include:
A HEALTHIER, MORE PRODUCTIVE WORKFORCE
With centralized oversight, gaps in patient records are eliminated, access to appropriate, necessary care is made more efficient. Care coordination encourages and equips patients to adopt healthier habits and empowers them to make more informed choices to maintain their health. Healthy employees are more productive, less likely to use sick days, and maximize the benefits of their health plan.
IMPROVED COST SAVINGS
By identifying high-risk patient populations before they incur costly medical intervention, employers can begin to reduce the trend in total medical expenses, which leads to stable premiums.
Employers gain access to data that reveals population health levels and risks, clarifying the overall value of their health benefit plan.
IMPROVED EMPLOYEE SATISFACTION AND PRODUCTIVITY
Employees who understand they have a care coordination program available to them are typically more satisfied with their benefits program.
Care coordination forms a conduit for continuous communication between the patient and provider, ensuring access to timely and accurate information that informs progress or possible modifications that need to be made to the patient’s treatment plan. Benefits include:
EXTENDED CARE TEAM VISITS
Care coordination serves as an extension of a primary care provider’s office-based care team. The primary care physician benefits from additional care team members who are interacting and monitoring their patients in-between office visits and informing the PCP of clinical improvements and progress as well as recent admissions and ER visits they may not otherwise be aware of until the patient’s next scheduled office visit.
CONTINUOUS VISIBILITY INTO PATIENT PROGRESS
Care coordination models glean frequent and accurate information about patients’ treatment histories, medication adherence, new symptoms, and maintenance of chronic conditions. In addition, the care coordination team can provide insights to mental health and well-being, fitness and nutrition, and social determinants of health. With more data, providers can make more informed decisions about their patients’ paths to treatment.
IMPROVED PATIENT OUTCOMES
Providers who take advantage of care coordination models typically see clinical outcomes improve for the patients they serve. Ancillary benefits of these models include care team motivation, practicing at the top of a providers’ license, and ultimately creating a pathway to practice value-based medicine without an over-reliance on traditional fee-for-service payments.
Care coordination leverages a value-based or performance-based reimbursement schedule, which rewards providers with financial incentives based on practice efficiencies and positive patient outcomes.
THE HEALTHCARE HIGHWAYS ADVANTAGE
Care Coordination improves communication between specialists and primary care physicians to maximize treatment plan effectiveness. Healthcare Highways’ model of coordinated care incorporates:
Deeply engaging providers who believe in collaborative care.
Healthcare Highways partners with providers who have demonstrated track records of efficient care protocols and improved health outcomes. These physicians are continuously monitored to meet standards of quality care, sharing in our commitment to lowering costs, increasing efficiency, and improving patient lives.
Empower effective care management through acquiring and sharing data insights.
Through ongoing data collection and analysis, Healthcare Highways ensures its providers receive continuous insights as their patients’ progress through their care journey. Easy access to meaningful data aids providers in proactively managing a patient’s ongoing healthcare needs.
Creating incentives for quality, efficiency, and patient experience.
Providers are financially rewarded for efficiently improving patient health outcomes through increased primary care engagement and monitoring. Healthcare Highways created marked member engagement and health outcome improvement using its care coordination model in Oklahoma over the course of just one year:
Hospital re-admissions dropped from 11.71 percent to 9.84 percent
Breast cancer screening rates increased from 63.81 percent to 72.04 percent
Colo-rectal screening rates increased from 30.53 percent to 41.56 percent
Employers intent on providing their employees a more effective suite of healthcare solutions should consider care coordination a prerequisite component of their health plan strategy. Not only will employees enjoy a higher quality of care, but the entire organization will reap economic benefits in the form of better data insights, a healthier workforce, and lower total cost of care.
CREAGH MILFORD DO, MPH FACOI | Chief Medical Officer, Healthcare Highways Chief Medical Officer of Healthcare Highways, Inc., and a National Academies of Medicine Fellow, Creagh Milford DO, MPH, FACOI has held senior executive positions with FullWell, Mercy Health, Massachusetts General Physician Organization, Massachusetts General Hospital, and Partners Healthcare. He holds a Doctor of Osteopathy from the Chicago College of Osteopathic Medicine, and a master’s degree in Health Management and Policy from the Harvard School of Public Health, where he continues to guest lecture. He also held positions with the Centers for Medicare and Medicaid Services and the Department of Health and Human Services.