The Success of Value-Based Care Hinges on Care Coordination

Health care professionals are increasingly using their available tools to facilitate seamless transitions and communication.

Why? Because care coordination is crucial to improving patient outcomes.

When doctors, hospitals, rehabilitation facilities and home care agencies collaborate effectively and everyone is accountable for their role in the patient-care process, patients — including your employees — receive efficient medical care at a reasonable price.

For example, as part of a good referral, primary care doctors tell specialists about their patient’s medications and health history, as well as why they referred the patient to a specialist. In a similar vein, specialists will ideally tell primary care doctors about any tests or procedures they performed and the results they received, as well as any medications they prescribed or discontinued. The same concept applies when patients transition from one institution to the next, such as from a hospital to a rehabilitation facility. In both cases, communication among providers is essential.

Here’s the background behind why better care coordination is key to better health care outcomes — and what strategies there are for tackling some of the current challenges.

Moving to Value-Based Care

The push for collaboration in health care complements value-based care models, which pay health care providers based on the quality, rather than the quantity, of their care. That’s because effective communication among providers helps them understand a patient’s comprehensive health history — not just the particular medical issue they’re treating. This reduces redundant tests and inadvertent errors such as potentially harmful drug interactions.

Though teamwork sounds like a commonsense practice, it’s far from routine in the health care industry.

In fact, up to half of the roughly 100 million referrals made to medical specialists each year are not completed, leading to missed or delayed diagnoses and treatment, according to the Institute for Healthcare Improvement.

The problem stems, in part, from the traditional fee-for-service reimbursement model, which pays doctors and hospitals based on the volume of services they perform, such as office visits or tests. Fee-for-service systems do not encourage communication and cooperation with providers in other health care segments to deliver care efficiently and holistically.

The result is costly and, at times, mediocre — or even harmful — patient care.

How the Health Care Industry Is Improving Patient Outcomes

The health care system is beginning to change. To strengthen the quality of patient care, doctors, hospitals and other providers have placed a new emphasis on coordinating care. Structured programs that address how to better manage medical care for patients have in particular pushed providers to communicate more effectively.

For example, Spectrum Health, based in Grand Rapids, Michigan, developed a care transition program to monitor patients after transferring them to a rehabilitation facility. Using registered nurses to work with facilities and software to track performance, Spectrum saw its patients’ skilled nursing facility days reduced from 966 days out of 1,000 to just 640 days out of 1,000.

But Spectrum is in the minority. In a recent report, NEJM Catalyst found that only 7% of health care organizations fully manage handoffs among a hospital, rehabilitation facility and a patient’s home.

On the outpatient side, care coordination is a key component of the Chronic Care Model, a systematic approach to helping patients manage chronic illnesses such as diabetes or heart disease. In this model, primary care doctors and their staff proactively oversee care for their patients — including referrals to specialists, hospitals or community agencies.

Overcoming Hurdles to Coordinated Care

For collaboration among providers to become routine, the health care industry will have to overcome numerous challenges, including:

  • A lack of easy information exchange between electronic health record systems from different vendors.

  • Resistance from other health care organizations to patient care coordination.

  • Patient opposition to working with a care coordinator, nurse or other health care provider to manage their interactions with the health care system.

Value-based care models are on the rise. As refreshed ways of organizing patient health become increasingly common in the industry and providers begin to feel the support of a system that values teamwork, collaboration among doctors, hospitals and others is only likely to continue improving.

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