Sg2 Strategic Countdown: Elevating Care Coordination
Policy makers, payers and patients are increasingly recognizing care coordination’s potential to reduce spending, improve outcomes and enhance patient engagement. Both public and private insurers are restructuring payments to support this previously undervalued function.How can your organization more effectively coordinate patient care across settings and over time? Sg2 offers the following five strategies.
- Align efforts with evolving payment and organizational focus. Care coordination initiatives should reflect the speed at which your local market is moving toward risk-based payment models. Risk-based payment will demand efforts much more closely aligned with ambulatory settings than traditional case management. Recognize, however, that you’ll need to expand your competencies in this area several years ahead of local market conditions.
- Reconsider your org structure. Executive-level oversight will help ensure that programs rooted primarily in acute care can transition nimbly and effectively toward broader initiatives. Some organizations in the most advanced markets have installed a senior leader to own care coordination across all sites.
- Identify and tier target populations. Focus initial efforts at the intersection of greatest patient need, highest organizational impact and best window of intervention opportunity. Your own employees, frequent users of your ED, specific chronic disease cohorts or individuals within an accountable care organization represent potential target groups. Organizations with the broadest risk-management experience often stratify every patient who touches their system to define care goals.
- Tailor roles. You have a range of options in selecting designated care coordinators, from nurses and social workers to individuals with relevant skills developed in nontraditional backgrounds. Both salaries and feasible staff-to-patient ratios vary considerably across these types of coordinators.
- Keep an eye on ROI. Even though an immediate return on investment will be difficult to achieve in a fee-for-service environment, potential ROI will grow dramatically as payment shifts toward risk contracts. Progressive metrics to track impact include avoidable ED visits, avoidable admissions and patient days per 1,000 members; percent of chronic patients seen by a physician within seven days of discharge; and average per-member per-month cost for each intervention group vs a base year.