By Melinda Young
Healthcare organizations need new methods to improve care coordination and patient-centered care. A co-author of a recent study proposes a method to determine whether a patient needs primary care or specialty care, naming the categories as “lifer” and “destination.”1
“We decided to evaluate care utilization by patients at this health system to better understand who this health system is serving and inform that by patients’ patterns of utilization,” says Mahshid Abir, MD, MSc, study co-author and a senior physician policy researcher at the Rand Corporation in Santa Monica, CA. “By virtue of better care coordination, you’re also checking the box of more patient-centered care.”
Abir and colleagues evaluated people who visited an academic medical center for specialty care or for highly specialized care vs. those who received routine care or specialized care. Patients could arrive from anywhere — locally and from out of state or internationally.
“When you’re a tertiary center, these are major referral centers and can get people from anywhere in the U.S. or in the world,” Abir explains. “If you are thinking about care coordination for someone who is coming to an academic medical center from a distance, specifically to receive this highly specialized care, the kind of care coordination they need is going to be different than someone who [mostly] needs primary care.”
This is why Abir and colleagues call patients who traveled far for specialty care “destination” patients. People who live in closer proximity are “lifer” patients. Care coordination of these two different populations should be tailored to their needs.
“If you treat all patients the same, you may allocate resources to a population that may not need the resources, or you may underallocate resources to patients who need them,” Abir says.
For example, a destination patient, such as a transplant patient who needs major surgery or multiple surgeries, would require more complex care management. “They have physical needs after surgery. They may have mental health needs,” Abir says. “They may need care coordination for more social determinants of health-type of needs.”
Those patients will require more intense care coordination. “Someone [a lifer] who just sees a primary care provider at the health system may not need care coordination with as many moving parts if they do require a specialty service,” Abir says. “If the person is not from the locality, the coordination of care has to happen wherever the person is from. This gets more complicated than local care coordination.”
Care coordination takes more resources for destination patients partly because they will return to their home states or countries after their surgery and care. This requires coordination between the academic health center and providers where the destination patients live.
“At the health system we studied, there is a service called complex care, and it’s responsible for identifying patients who have complex multiple care needs,” Abir explains. “They try to do more intense care coordination because it is complicated when someone has that much of service needs.”
When a patient is traveling some distance to the health center, care managers need to look at the patient’s home community to see what healthcare services are available. “What kind of wound care or physical therapy is available?” Abir asks. “We need to know about our destination patients and where they come from. We need to understand the landscape of where they’re living and how we coordinate care in the community that the patient is originally from and presumably will go back to after they get specialty care from a tertiary care center.”
Efficient care coordination may require case managers/care coordinators to spend more time on out-of-area patients and less time on local patients.
Caring for destination patients is difficult for providers, as well. Abir sees patients who visit the ED to receive a second or third opinion on their medical concern. Then, they go home via a long drive.
Physicians send patients home to the same primary care providers that the patients believe are not caring for them. It is incredibly difficult, Abir says. “As physicians, I feel it ties our hands,” she says. “For care coordination, it’s also complicated.”
Care coordinators and providers need the patient’s medical information in hand, and it is not always available when they arrive at the out-of-area facility. To obtain all the information necessary to care for these patients, care coordinators need tools to make their work more efficient. With limited resources, the answer may be to shift care coordination work to the more complex out-of-area patients.
“What tools can we provide care coordinators to access the information they need to help patients from remote locations so they can be more efficient with their time?” Abir asks. “Moving away from a one-size-fits-all approach to care coordination, the idea is to leverage technology as much as possible to make the life and work of care coordinators easier. We can use information technology between health systems — not just locally in a state, but across states. All this is needed because people don’t stay in one place.”
Abir and colleagues found that using the lifer and destination patient definitions helped the healthcare facility to identify opportunities for tailoring care coordination to those unique groups and to allocate resources more efficiently.
“The health system we’re studying implemented many of the strategies that the study recommended,” Abir says. “My hope is that other health systems — whether they’re tertiary care centers or community-based care systems — use these strategies to better understand the population they serve.”
This is a data approach to understanding a health system and patient population and to pivot resources to better inform patient needs. “This needs to happen on a continual basis,” Abir says. “The world is changing at a fast pace, and the population is changing.”
Every health system has the data they need. They just need to invest in resources and perform a quarterly analysis of their patient population. “Just be nimble and be able to modify the way we deliver care in a data-driven way,” Abir says. “They can find out where patients are coming from and what kind of care they are coming to the health system for.”
REFERENCE
- Lambrecht J, Abir M, Seiler K, et al. Conceptualizing lifer versus destination patients for optimized care delivery. BMC Health Serv Res 2023;23:1190.
Healthcare organizations need new methods to improve care coordination and patient-centered care. A co-author of a recent study proposes a method to determine whether a patient needs primary care or specialty care, naming the categories as “lifer” and “destination.”
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