Care coordination is a valuable practice that healthcare providers can embrace within their organizations. By creating a more cohesive healthcare environment, providers can readily address patient needs and improve care outcomes.
Care coordination refers to organizing patient care processes and keeping all relevant parties engaged in these activities to improve the effectiveness of care. The main goal of care coordination is to meet patients’ needs and ultimately improve the quality of care. Involving all of the right providers and professionals in a patient’s care ensures each therapy or process is handled by the person best suited for the job.
Modern healthcare systems are often disjointed, leading to a lack of communication between Primary Care Physicians (PCPs) and specialty providers. Additionally, patients also experience a lack of clarity surrounding who to contact and when for different issues. Care coordination seeks to bridge these gaps by encouraging regular communication and active involvement from every provider.
Primary Care Physicians, nurses, pharmacists, support staff, and social workers are often involved in care coordination, but this will vary based on the patient’s health needs and the level of support required from providers.
While care coordination is generally considered a team effort among healthcare providers, it also includes communication with patients’ families. Including family members is valuable for ensuring preferences are met and care needs are handled safely according to a patient’s health history. In some cases, patients are unable to provide this information themselves, making family members valuable in care coordination.
Care coordination can include a wide range of activities such as:
A strong example of care coordination is the transition to long-term care. Patients who are residents of an assisted living community have providers at their facility. Following acute care, providers must communicate with community physicians regarding care plans and any changes to medication. Care coordination in these settings also involves working with the patient and the family to establish goals and explain the new care plan.
Care coordination offers many benefits for healthcare providers and patients.
Well-coordinated care removes the burden on patients and their families by establishing clear goals and care plan items. Healthcare needs can be a gray area for many patients, but having concrete action steps in place can put patients and their family members more at ease throughout the course of care.
This improved experience can be helpful for establishing a positive reputation for your facility or practice. With happier patients, it can also be easier to align self-management practices to proactively maintain health and improve outcomes over time.
A collaborative care team with active knowledge sharing ensures all information is factored in when caring for a patient. This practice ensures every patient receives the right care in the right setting at the right time. A strong care coordination structure also helps streamline the delivery of these services, helping to reduce complications that may arise without a timely response.
Improved outcomes can include reduced hospital readmissions, increased adherence to care plans, and reduced medical errors. Care coordination can also improve the management of chronic conditions, which often require overnight care from multiple providers.
Effective care coordination optimizes the use of healthcare resources to cut costs for facilities and patients. Factors like duplicated services and hospital readmissions lead to higher costs, and these are often a direct result of poorly coordinated care. Reducing the financial burden for patients contributes to overall satisfaction, and cutting down on resource usage can lead to long-term savings for acute hospitals and care facilities.
Multiple providers and professionals see a single patient, and each one learns information about the patient’s needs. Collaboration ensures information is shared between providers and professionals to ensure continuity of the care plan. If anything changes, all parties are updated about adjustments to the care plan.
Care coordination makes it possible to establish treatment that is more accessible to the patient. Rather than asking a patient to visit multiple specialists, providers can determine a course of action together to minimize the number of office visits and optimize at-home care plans. Care coordination may also involve planning home visits to make care more available to patients who are not equipped to visit multiple doctors.
Barriers to physician visits can be a challenge for maintaining care plans. Making treatment more accessible with care coordination makes it easier to align with quality measures like follow-up visits and medication adherence.
Implementing care coordination practices can lead to immense improvements for all types of care facilities. Support care coordination goals by:
First Docs is a physician-first group dedicated to improving care outcomes for skilled nursing facilities (SNFs), assisted living communities, and acute hospitals. With one of our attending physicians, your team can optimize care coordination to effectively meet patients’ needs and cut care costs. Contact us today to learn more.