Health Care Reform: Consider Care Coordination

Blog posted by Nancy Rehkamp (retired)

I have been reading a lot of the articles, blogs, and summaries describing the health care reform legislation. One key issue attracting attention is the high cost of patient readmissions. Today, roughly 70 percent of readmitted patients were originally discharged with no follow up services. Although many believe that the bulk of reform measures will be focused on hospitals and other facilities, maybe the reform will ultimately mean changing the way communities provide care.

Many of the provisions of the bills change the payment mechanisms to enhance the coordination of care and the transitions of care. In addition, some of the penalties in the bill focus on things like readmissions—an issue that is largely about how someone receives care and support once they leave the hospital, or before they come to the hospital. The bundling, medical home, and value-based reimbursement demonstrations will focus on changing care to reduce costs across the sites of care, but the savings will largely come from reducing acute care and emergency room services as well as improving the services offered in the community.

The ironic thing about this focus is that to be successful we will be relying heavily on informal caregivers, the ability of patients and residents to engage more meaningfully, and on a variety of providers and nonprofit organizations who have not historically integrated services or programs with acute care. A key driver of this community-based care reform will be driven by funding that many community nonprofit providers have not traditionally accessed.

The glue that will hold much of this community integration and transitions of care together will be care coordination and case management. Numerous studies have shown is that care coordination makes a huge difference to patients, their families, and the providers in improving communications, accessing the right services, and assuring follow-up and follow-through on best practices.

The challenge is that there is a “sweet spot” for care coordination in which health care costs are reduced, but not all care coordination results in low costs and better care. We almost always get the better care but not at a low cost.

Innovations evolve from community-based services and care models is where the action is going to be. This presents tremendous opportunities for communities because, currently, I am not sure anyone really ‘owns’ that space.

What do you think? Will the bulk of change be located in doctor’s office, the hospital, or somewhere else entirely?