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Coming to Terms
The term, Coordinated Care, has been thrown around quite a bit over the past few years, but whether or not it can become the solution to many healthcare woes is still to be seen.
While the majority of healthcare professionals believe that coordinated care is the key to improved quality care and lower healthcare costs, there are several barriers creating challenges, and there is no panacea that addresses all obstacles.
In order for coordinated care to work, we must find a way to increase communication between all providers. Unfortunately, the idea that electronic health records can increase communication between all patient providers has proven to be a shortsighted wish. Technology can fill in the gap, but not until all the different brands and types of EHRs can seamlessly connect. When a patient can see their local primary care physician, go to any hospital, specialist, nutritionist, and even ophthalmologist, and all their medical records and related information is available, coordinated care can begin to meet the monumental expectations it carries. As it stands today, many EHR companies create software that is unable to share information across all the departments in the same hospital. So, developing a program that will allow communication across various software platforms and countless manufacturers is a daunting task that is not likely to be solved until regulations are put in place requiring common coding, or the development of intermediary data companies that operate similar to middle man intermediary banks.
While their residents are greatly in need of coordinated services, rural communities are at a major disadvantage when it comes to incorporating coordinated care. The high cost of implementing an EHR system, and paying the additional personnel required to meet the Affordable Care Act’s quality-improvement measures, restricts many providers. While some rural hospitals are part of larger health systems, many small communities are too small to participate in Medicare ACO programs, which require a minimum of 5,000 beneficiaries. With approximately 19.3% of the US population living in rural areas, failure to incorporate coordinated care is not only a major disservice to those patients; it reduces the overall beneficial impact.
One percent of American patients consumed 21 percent of the nearly $1.3 trillion spent on healthcare in 2010. These “super-utilizers” are high-frequency patients or frequent fliers who commonly suffer from heart failure, diabetes, kidney disease, and a significant psychiatric issue. These patients most often end up in emergency rooms, even when they could receive care more cost and time efficiently in outpatient settings. They often end up back in the hospital within a month after discharge. For coordinated care to operate at optimum levels, programs need to recognize the social determinants of health. When a patient doesn’t understand their physician’s orders, can’t find a ride to their follow-up appointment, or is unable to pick up their prescription, they are likely to end up back at the ER. “We’ve seen situations where for want of a $20 cab ride to get to dialysis, a patient ended up with an emergency hospitalization costing $20,000,” said Tim McNeill, chief operating officer of Medical Mall in Jackson, Mississippi.
Coordinated care programs that include knowing and understanding the lifestyle issues of patients, and addressing gaps in information and access to basic and medical needs, will help provide the greatest reductions in healthcare spending. To ignore the patients’ lives outside the doctor’s office or hospital misses some of the critical influences on their health.
Coordinated care is a high goal to reach for, but it is definitely worth it. To find success, we must create easy and efficient means of communication for all providers, regardless of their EHR system. With the numerous forms of technology that are available, identifying transitional options may provide stopgap solutions as we wait for an efficient EHR systems translator. Punishing rural and low socio-economic communities who cannot afford to implement coordinated care systems goes against the goal of providing quality, standardized care. As such, we must work together, in true coordinated care ideology, to help struggling community health services. And, we must recognize how lifestyle factors affect a patient’s health, as well as their access to care and adherence to physician orders. We cannot treat one half of a patient and expect them to be 100 percent healthy. To truly be effective, coordinated care will need to look at the patient as a whole, and share each medical and social aspect with everyone providing care.
Boodman, S. (2013). Coordinated care critical for reducing U.S. health spending. Medcity news. Retrieved online Oct. 28, 2013 from http://medcitynews.com/2013/10/coordinated-care-critical-reducing-u-s-health-spending/
Curaspan Connections. (2012). Care coordination is key to fixing health care.KevinMD.com. Retrieved online Oct. 27, 2013 from http://www.kevinmd.com/blog/2012/03/care-coordination-key-fixing-health-care.html
Kutscher, B. (2013). Shift to coordinated care. Modern Healthcare. Retrieved online Oct. 27, 2013 from http://www.modernhealthcare.com/article/20131019/MAGAZINE/310199956