Three Ways to Be a Better Care Coordination Partner

During our recent webinar, we discussed why sharing data and coordinating patient care across the continuum is critical as value-based payment (VBP) programs continue to grow and evolve. Our co-host, Kim Majick, Executive Vice President at Carespring, represented the post-acute perspective; I gave voice to the acute side, and our discussion covered the evolution of care coordination, and how that evolution comes with challenges – and solutions.

A consistent push towards care coordination has been underway for quite some time, starting with readmissions penalties, accountable care organizations (ACOs) and the original bundled payments for care improvement (BPCI) program. The push intensified with the IMPACT Act and mandatory programs like CJR and the forthcoming cardiac bundle. All of these programs and regulations are a testament to how CMS thinks it’s important for providers to work more closely on patient care, and how patients should be able to access quality information about providers.

Increased collaboration comes with benefits – and challenges – for hospitals, post-acute providers and patients.

From Kim’s perspective, with more collaboration, hospitals now have a better understanding of what post-acute providers do and how they operate. The challenges, however, come in working with multiple hospital partners. While having many referral sources help sustains PACs, sharing data at different times and in different formats (e.g. surveys, spreadsheets, portals, and EMRs) is a logistical challenge. Most hospitals are asking for the same information, but in a slightly different way.

Logistics are difficult for hospitals, too. Over time, managing partnerships with hundreds of post-acute providers became too difficult and they realized the need to narrow their networks to a fraction of that. Figuring out which providers should be part of a preferred network presented a new challenge. Hiring staff to track and follow-up with patients quickly became more critical, but manually tracking patients as they moved into post-acute care and home is incredibly time consuming.

On the patient side, with every provider trying to track outcomes and follow-up, sometimes that becomes a burden for the patient (i.e. receiving multiple phone calls from multiple providers responsible for a single episode). These are the challenges that new payment initiatives are creating.

Even the Best People Need (Good) Tools to be Effective 

Even with best intentions and a high-performing staff, things fall through the cracks unless there are tools that enable them to do the right thing at the right time. Furthermore, high-level clinicians should be working with patients and on patient care. Arming clinicians with tools to support all the logistics that drive care coordination – and allowing them to spend more time with patients – helps drive better outcomes all around. Sharing these tools across providers further drives better patient care, without an unnecessary amount of patient follow-up.

If all providers are using the same tools:

  • The data and information is apples-to-apples – and there’s no need for manual entry
  • There’s a shared language – and everyone is on the same page
  • There’s more trust that everyone is doing what’s right for the patient – and the patient gets the care they need
  • The patient – and providers – see better outcomes

The bottom line is that care coordination will continue to evolve and providers have to adapt. Here are three takeaways that we think will help providers become better care coordination partners:

  1. Partnerships are here to stay. The increased acceleration toward value-based payment models isn’t slowing down.
  2. Put Care Coordination into Practice. Hire the best people, but arm them with the best tools that allow them to spend their time effectively intervening with patients.
  3. Data is Your Friend. Understand your data and how you’re performing with value-based programs, and share that data with your care coordination partners.