Thursday, March 15, 2012

Care Coordinators: The Commonwealth Fund Shows Why ACOs Should Fund Them

In yesterday's post on the re-emergence of the "medical director" as a force to be reckoned with, the Disease Management Care Blog also mentioned care coordinators.   There's a reason why they were prominent feature in The New York Times' recent ACO article on Advocate's success.

The DMCB defines care coordinators as credentialed non-physician medical professionals - usually but not always nurses - who have three responsibilities:

1) maximizing the "health insurance benefit"  - what's often lost is the reality that insurance coverage varies and is imperfect.  It takes time and effort to match a patient's clinical needs with payments, networks and limits.  That includes fee-for-service Medicare.

2) enabling the patient to address "care gaps"  - and most DMCB readers understand that that is accomplished by enabling patient participation in and control of their care.

3) maximizing community resources  - there are a host of public and private services "out there," and it's a full time job to help patients access them.

While well-meaning traditionalists will argue that letting nurses into the doctor-patient relationship is a risky proposition, check out this short article that just appeared in the Archives of Internal Medicine.  Michel Doty and colleagues tapped the Commonwealth Fund's 2010 International Health Policy Survey of over 19,000 adults from 11 countries.  In it, they asked respondents about the involvement of a "care coordinator" and correlated it with self-reports on the use of health care services. 

While the odds ratios vary, having a care coordinator emerged as a strongly independent and statistically significant predictor of better appointment scheduling, access to test results, specialty care and follow-up after discharge.  Patients with access to that kind of care had odds ratios in the 0.50 range, meaning that they were about half as likely to report problems.

While the Archives article is based on self-reports, is retrospective, doesn't precisely define "care coordination" and there may have issues with how that gets translated across cultures and languages, the information is telling: having a trusted third party in the mix of care services can have a powerful impact on health care utilization that leads to decreased cost and higher quality.

Last but not least, while the authors point out that "care coordination" is a bedrock principle of the Patient Centered Medical Home (PCMH), they neglected to point out that this is also basis for population health management

Take it from the DMCB: medical directors have little reason to care if the care coordinator is on the PCMH payroll or offered by a third party population health management vendor, just so long he or she gets the job done, maximizes the benefit, engages the patient in self care and makes sure community resources are accessed. 

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