Post-acute care costs the healthcare industry more than $100 billion annually and readmissions cost $30 billion to $40 billion each year. Now that healthcare has shifted to value-based reimbursement, the importance of care coordination has been elevated. When a patient is seen by multiple providers, such as a primary care physician and one or more specialty providers, that patient’s care must be coordinated between those providers to ensure that the care provided by all is efficient and effective. It has become a key feature of evolving care models (Population Health Management or PHM, and Value-Based Care or VBC) designed to avoid episodic care for patients, with a focus on preventative care, reducing the onset of disease, slowing disease progression, and helping patients build healthier habits and lifestyles.
Financially, value-based care coordination can help reduce costs incurred both by the patient and the independent physician. When reimbursement is based on the quality of care rather than the quantity, your emphasis has to be on optimizing each patient visit and ensuring that your patient is knowledgeable, leaving your office with the appropriate treatment plan, and follows through with the physicians directives. Otherwise, time and money can be wasted on unnecessary repeat office visits, lab tests, and even hospital admissions.
VALUE-BASED CARE COORDINATION IS NOT CASE OR DISEASE MANAGEMENT
It has a much wider focus. Traditional case management or acute episode management addresses a single event with a focus on utilization, length of stay, and benefits management offering a short term impact. Traditional disease management or chronic condition management addresses a single medical condition, provides education on that condition, and self-care adherence. It has a narrow focus and limited impact.
Comprehensive care coordination addresses the whole person; including management of physical and psychosocial issues, community resource referrals, care coordination, behavior modification, healthcare coaching and self-care adherence. It also offers a care transition component, an interdisciplinary team and provider engagement. The primary goal is sustainable behavior change that impacts both the patient and provider.
Unlike case managers or care managers of the past, new skills are needed to produce improved results:
- HEALTHCARE COACHING — Can be defined as helping patients gain the knowledge, skills, tools and confidence to become active participants in their own care so they can reach their self-identified health goals.
- MOTIVATIONAL INTERVIEWING — A gentle form of counseling – which is extremely effective in fostering change in a wide range of health behaviors for all demographics. It works by activating patients own motivation for health changes which significantly improves patient engagement and facilitates a stronger adherence to their Physician’s directives.
WHAT ARE THE TYPICAL MONTHLY CHRONIC CARE MANAGEMENT ACTIVITIES?
- First priority: Ensure patient is adhering to physician’s directives
- Identify any obstacles patient may have adhering to directives
- Ensure the beneficiary’s receipt of all recommended preventative services
- Monitor the beneficiary’s condition (physical, mental, social)
- Provide education and address questions from the beneficiary, family, guardian, and/or caregiver
- Motivate patient and promote self-management and investment
- Identify and arrange needed community resources
- Communicate with home health agencies & other community providers utilized by the beneficiary
- Implementation, maintenance & modification with communication of Care Plan
WHY SHOULD PROVIDERS ENGAGE THIS NEW APPROACH TO PATIENT CARE?
Health care organizations that leave now can put in place the necessary capabilities and processes that will give them first-mover advantages and increased market share, while others are left behind. And it is hard to disagree with the concept of value-based care and population health management. Done correctly, these care models achieve the Quadruple Aim, improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care. As Benjamin Franklin once said “An ounce of prevention is worth a pound of cure.”
For more detailed guidance on how to leverage care management as a reimbursable service within your practice, please contact us here to schedule a complimentary consultation with a Vigilance Health Care Management Specialist.