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Ask a doctor if she thinks her hospital does a good job at care coordination or an administrator or board member and shed probably say yes. She might admit to room for improvement, but in all likelihood, she would think she and her peers do a good job taking care of patients in and out of the acute care setting. But the reality is different, says quality guru and Harvard professor Lucian Leape, MD, chairman of an eponymous institute at the National Patient Safety Foundation.
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Since Advocate Health Care began embedding case managers in primary care offices, hospital admissions and emergency department visits have decreased and length of stay has dropped, says Sharon Rudnick, vice president of outpatient care management for the Chicago-based health system.
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Aetna started partnering with physician practices to improve outcomes by coordinating care in 2007 before the term accountable care came into use, says Randall Krakauer, MD, national medical director for Aetna Medicare.
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A study of three primary care practices that participate in Cignas Collaborative Accountable Care model, which includes care coordination for at-risk patients, showed significant cost savings and improved quality of care when compared with other practices in the same geographic area.
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Hospitals that have physician offices connected to and affiliated with them now have another option for getting certified for a Primary Care Medical Home. Along with programs run by the National Committee for Quality Assurance (NCQA), The Joint Commission started offering such certification in late February.
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The Joint Commissions Center for Transforming Healthcare has started working with 20 hospitals in South Carolina to improve their safety by examining systems, processes, and structures in an effort to minimize variability in practices.
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The Centers for Medicare & Medicaid Services (CMS) has started pilot testing of two more survey tools to go with the infection control pilot it began testing last year.
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As payers and providers recognize the value of care coordination for people with chronic conditions and complex care needs, opportunities are opening up for case managers in primary care practices.
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Great strides have been made in the treatment of sickle cell disease, the inherited blood disorder that occurs most commonly in African-Americans. Patients with the disease used to die before reaching adulthood, but today many patients live well into their 40s and beyond.
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In an effort to drive down health care expenditures, a key target of state legislatures and healthcare policy makers in recent years has been frequent users of the ED. The thought is that many of these patients are using the ED for routine or non-urgent care when they really should be opting for less-expensive care settings.
