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What Is Coordinated Care & Why Is Clinical Care Coordination Important

Chronic diseases are a leading cause of death and disability in the USA, and the number of Americans affected by chronic illnesses is estimated to hit 50% by 2025. Co-morbid diagnoses are a significant consequence of this, with one in four US adults struggling to manage two or more chronic conditions simultaneously.

As a result of this surge in chronic health problems, an ever-increasing number of Americans take several medications, receive care from different providers, and are in and out of the hospital and health clinics multiple times each year.

Unfortunately, as payers know all too well, the cost of this care is expensive, and as of this year, 86% of health care costs are being consumed by the management of chronic diseases.

To mitigate the skyrocketing costs of healthcare and promote more effective treatments for individuals with chronic diseases, payers and providers collaborate on innovative care models. These include person-centered care, value-based care, and, the subject of this article, coordinated care.

What Is Care Coordination in Healthcare?

As Americans continue to develop multiple conditions, it becomes critical for care to be coordinated across all the providers involved in a patient’s care. By eliminating silos and ensuring that care is synchronized across the patient’s various providers, redundant procedures and tests can be avoided, and healthcare costs can be reduced.

In short, care coordination is the effort to bridge gaps along the care pathway, ensure the patient’s needs are met, and deliver high-quality health care. The coordination of care involves the entire care team, including the patient receiving care, their Care Manager, family, community providers, and healthcare professionals, all working together to share information and collaborate for the patient’s good.

What Types of Care Coordination Are There?

There are many types of clinical care coordination, with some models optimized for acute conditions, others for chronic disease, and others for patients requiring long-term/post-acute care.

1. Chronic Care Coordination

One of the top coordinated care approaches for individuals with chronic conditions is called the Guided Care model.

Pioneered by researchers at Johns Hopkins University, this method works by having a specialized registered nurse manage a patient’s care. The nurse develops a care plan in collaboration with primary care physicians and oversees the execution of the plan.

This approach to care coordination for chronic conditions has been shown to decrease costs by 11%.

2. Acute Care Coordination

Acute injuries and illness can force individuals to seek care outside of their network in emergencies. This opens the door to miscommunication between out-of-network providers and in-network healthcare professionals once the patient is discharged.

Acute care coordination relies on solutions like InfoMC’s care coordination software Incedo™ to help mitigate risks related to poor communication and lack of collaboration. Tools like InfoMC’s Care Team Portal make it easy for providers inside and outside a patient’s network to coordinate, share data, and facilitate a proper transition of care post-emergency treatment.

The goals of acute care coordination are to reduce hospital readmission rates, lower costs by preventing duplicate treatments/testing, and improve the population’s overall health.

3. Long-Term Care Coordination

Patients requiring post-acute or long-term care (LTC) typically spend time at multiple types of facilities or receive ongoing home-based services.  Coordination of LTC services ensures that patients and their families understand the care plan. Also, it equips the patient with support services to help them feel as comfortable as possible if they’re in a facility, gets them back in their home as quickly as possible, and ensures the delivery of necessary home and community-based services.

Care coordination practices for LTC include the coordination of services to help patients transition back into the community after hospital and nursing homestays. Care coordination activities can consist of the timely transfer of medical information, collaboration with patients’ care team and family members, and ensuring direct care is resumed upon the patient’s transition out of the facility. Coordination of home-based LTC services includes the health, personal, and support services to help patients stay at home and live as independently as possible.

Coordinating these LTC activities help to promote the highest quality of health care for patients both in long-term care facilities and those receiving home-based services.

What Are the Benefits of Care Coordination?

As you can see, coordinating care and collaborating on creating care plans can have many advantages. In addition to the benefits of reducing costs and eliminating duplicative services, here are a few more advantages of care coordination:

  • Encourages collaboration between everyone on the care team — the patient, their family, and all the providers and stakeholders involved in the patient’s care.
  • Establishes clear communication, using care coordination software like Incedo™ to give the care team a mechanism for communicating with or about a patient.
  • Streamlines care and encourage patient engagement by allowing visibility and input into the care plan, including concerns, interventions, and goals.

Ensures timely and comprehensive sharing of clinical, admission, discharge and transfer information with the entire care team. What Does the Future of Care Coordination Look Like?

Healthcare solutions companies, like InfoMC, are driving innovation and constantly looking for better ways to enhance the patient experience and improve care outcomes using technology designed for coordinating care.

In step with these goals, the future of care coordination will be about finding new ways to implement remote technologies, such as Bluetooth monitoring devices, so that the care team can better monitor the patient’s health.

For example, current Bluetooth devices enable patients to measure their blood pressure. Advances in our software will soon allow this data to be automatically uploaded to Incedo™, where the care team will have immediate access to this data.

Remote patient monitoring like this will improve all aspects of care, reduce costs by reducing doctor visits, helping patients take a more active role in their care plan, and give providers the most up-to-date data.

Furthermore, as machine learning, artificial intelligence, and other technologies advance, care coordination should become more manageable and innovative, with increased automation enabling payers and providers to coordinate care on autopilot.

Learn More About How Incedo™ Enhances the Care Coordination Process

InfoMC’s coordinated care platform, Incedo™, equips you with the tools and configuration capabilities necessary to succeed in today’s ever-changing and cross-functional healthcare environment. Incedo™ enables payers to take a hands-on approach to care coordination, processing actionable data to deliver the appropriate care, and improving efficiency through advanced automation.

To learn more about how InfoMC can help you coordinate care, contact us today. 


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