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Organizations Seek Care Coordination Improvements, Fall Short

Interest in care coordination improvement is reaching new highs, but not so much in terms of financial support.

By Kyle Murphy, PhD

Interest in care coordination improvements fails to have the financial backing necessary for realizing their benefits to providers and patients, according to a recent survey of healthcare professionals.

Eighty-six percent of respondents to a Digital Collaboration Solutions survey listed care coordination improvements as a top-five priority, but more than half report not having a budget dedicated to supporting these efforts.

"Over half of the respondents believe that improving care coordination is a no cost by-product of clinical delivery and perhaps leadership is under-estimating the time, effort and focus it takes to tackle care coordination improvements and its impact on the organization," the authors state. "The survey also indicates that over-worked clinical teams are continually being asked to do more with less, which eventually results in diminishing returns and disillusioned clinical teams."

The largest number of respondents to the DCS survey belonged to acute care hospitals (39.4%), followed by skilled nursing facilities (22.5%), integrated delivery networks (15.5%), and ambulatory physician offices (15.5%).

Tops on respondents' lists for care coordination improvement projects are four items:

  • Improving transitions of care with patients, families (60.6%)
  • Reducing 30-day readmission rates (60.6%)
  • Improving patient experience measures (57.7%)
  • Improving transitions of care between facilities (54.9%)

By and large, the focus is on improving health information exchange as patients move between care settings and ultimately to their homes. According to the authors, these findings speak to regulatory mandates forcing healthcare organizations and providers to focus on these areas in the near term:

It appears that most of these organizations are grappling with the impact of the “here and now” regulations that impact outcomes and revenue. The results indicate that they may be only beginning to feel the impact of new payment models that will necessitate better coordination of effort across the continuum, better population management strategies, more effective care plans to chronic care patient, and lower cost delivery to ensure profitability over the long term. 

A potential concern arising from this here-and-now perspective is failing to prepare properly for value-based care, much of which comes into play in 2017 as the Centers for Medicare & Medicaid seeks to implement the Medicare Access and CHIP Reauthorization Act (MACRA).

That being said, a majority of respondents (70.4%) indicated improving patient outcomes to the important factor for implementing care coordination improvements, so their intentions are in the right place. And they will be looking to do so across their entire care networks (40.8%) rather than only inside their own organizations or at a limited number of sites.

While not mentioned explicit, meaningful use requirements include measures on transitions of care and patient education.

Another disconnect emerging from the survey indicates that care coordination efforts are on the whole focused on process improvement — which 77 percent of respondents reported — but processes likely remain undefined and unavailable for assessment.

"Clinical staff involved in care coordination are smart and motivated team members," the authors maintain. "However, most are not trained or experienced in professional process improvement. The goal and the effort is sincere, however overextended clinical staff may be lacking the tools and techniques that could impact results with a more formal approach and management."

In keeping with these findings, the survey also reveals that care coordination improvements tend to be reactive rather than proactive, with 65% of organizations approaching these efforts opportunistically.

"Due to its lack of leadership, care coordination improvements are driven by reactive clinical teams needing to fix problems and respond to poor measurements," reads the report. "This lack of a systematic approach leaves many improvement opportunities unrealized and indicates inefficiency in prioritization. It could also be indicative of a fire fighting culture when the opportunity exists to prevent fires from happening in the first place."

While the survey captured several deficiencies in care coordination improvement initiatives, it did highlight several best practices, including that care coordination improvements take focus and effort, clinical staff need to own the effort with close executive sponsorship, and the effort requires process thinking.

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