The Art of Care Coordination in Delivering Quality Patient Care

In the intricate world of healthcare, the term “care coordination” is often bandied about. Yet, its true meaning and significance might not be immediately apparent to everyone. So, what exactly is care coordination?

Simply put, care coordination is a joint effort between healthcare providers and patients, where they collaborate to manage various health conditions, make health-conscious choices, and arrange healthcare tasks effectively.

The primary goal of this collaborative effort is to improve patient outcomes, increase safety, and deliver more effective care. This process is not just about managing illness but also about promoting health and wellness, making it a cornerstone of quality patient care.

Understanding the Importance of Care Coordination

To fully grasp the importance of care coordination, we need to look at some startling statistics. 

As per the data from the Centers for Disease Control and Prevention (CDC), chronic conditions like heart disease, cancer, or diabetes affect six out of every ten Americans.

These chronic conditions are not just health issues; they also have significant economic implications. They not only lead to death and disability but also drive up healthcare costs. In fact, of the $3.5 trillion in annual U.S. healthcare expenditures, a staggering 90% is spent on people with chronic or mental health conditions.

Given these figures, it becomes clear that managing chronic conditions is a critical aspect of healthcare. This is where coordinate care comes into play. By providing care coordination services, healthcare practices can help patients manage multiple chronic conditions.

These services offer more than just advantages for patients; they are essential for practices to comprehend and put into action as they pave the way for success in value-based care. This healthcare delivery model prioritizes patient outcomes over the quantity of healthcare services rendered.

Chronic Care Management (CCM) and Its Role in Care Coordination

Recognizing the importance of managing chronic conditions, the Centers for Medicare & Medicaid Services (CMS) has identified Chronic Care Management (CCM) as a key component of effective care. To encourage healthcare providers to offer these services, CMS pays a CCM fee for certain services.

CCM covers a broad range of activities. It might include evaluating a patient’s requirements, promoting preventive check-ups, or managing medication schedules.

Broadly speaking, care management activities are in line with CMS’s strategy to back healthcare services that take place beyond the confines of a medical office. This is a significant shift from traditional models of care that focus primarily on in-office visits.

Fulfilling the prerequisites for the CCM fee could result in healthcare practices earning $43 per month for each Medicare patient who has at least two chronic conditions. This fee is applicable to care services that may not necessarily occur within the clinic’s premises but are instrumental in assisting patients in managing their conditions. By meticulously recording instances of care coordination, healthcare practices can claim the CCM fee, thereby offering monetary motivation for these practices to actively participate in care coordination.

The Five Core Competencies of CCM

The CCM program is built around five core competencies:

1. Use of certified EHR technology: This involves using electronic health records (EHRs) to document and track patient information, facilitating better communication and coordination among different healthcare providers.
2. Maintaining an electronic care plan: This involves creating a comprehensive, patient-centered care plan that is accessible to all healthcare providers involved in the patient’s care.
3. Patient access to care: This involves ensuring that patients can access healthcare services when they need them, including after-hours access for urgent needs.
4. Facilitated transitions of care: This involves coordinating care transitions, such as when a patient is discharged from the hospital to home or to a skilled nursing facility.
5. Coordination of care: This involves coordinating the various aspects of a patient’s care, including primary care, specialty care, and ancillary services.

In order to set up a Chronic Care Management (CCM) program, a healthcare practice needs to register patients, charge for the provided service, and identify the patients who qualify for the program.

The Role of Greenway Care Coordination Services (GCCS)

While compensation is now based on patient outcomes rather than the quantity of services rendered, the responsibility for managing their conditions still lies with the patients. This is where Greenway Care Coordination Services (GCCS) steps in, partnering with practices to enhance care for patients with chronic conditions and meet the criteria for the CCM fee.

GCCS takes the reins in coordinating and managing care on behalf of the practice. Their care team interacts with patients via a digital platform, offering digital guidance on aspects like nutrition, exercise, and medication adherence, among other health determinants. 

GCCS also meticulously documents all care coordination interactions, enabling practices to effortlessly claim the CCM fee.

GCCS is integrated with the EHR system, allowing practices to identify and register eligible patients without causing any workflow disruptions. The outcome is a unified view of patients and efficient billing processes.

The Influence of Care Coordination on Patient Outcomes

The influence of care coordination on patient outcomes is significant. By fostering a unified approach among all healthcare providers involved in a patient’s care, care coordination aids in averting medical mistakes, minimizing unneeded tests and procedures, and enhancing the overall standard of care.

Patients who receive coordinated care are more likely to have their health needs met, less likely to experience medical errors, and more likely to be satisfied with their care.

Moreover, care coordination can also improve health outcomes by assisting patients in managing their chronic conditions more effectively.

For example, care coordination can help patients with diabetes control their blood sugar levels, reducing the risk of complications such as heart disease, kidney disease, and nerve damage.

Similarly, care coordination can help patients with heart disease manage their medications and lifestyle changes, reducing the risk of heart attacks and strokes.