Value-based care models can be implemented through a well-designed care coordination system that forms an efficient liaison between multiple stakeholders. Collaboration and patient preferences are important aspects of care coordination that supports multiple activities in a cohesive manner. Care coordination systems must be well-designed to promote safety, efficiency, and effectiveness. The article discusses care coordination measures proposed by the Agency for Healthcare Research and Quality, and explains the example of care coordination strategies for youth with traumatic brain injuries (TBI).
Geography: United States; Focus Area: The impact of care coordination on value-based care
Value-based care models have been consistently promoted by the US department of health and human services, to address inherent flaws of the fee-for-service payments. In value-based care, providers are to achieve better outcomes at reduced costs by promoting high-quality care, care coordination, and a patient-centered approach (Office of Health Policy, ASPE, 2021).
The Inherent Demands of Value-Based Care Models
In a value-based care system, information must flow between multiple entities such as hospitals, community health centers, pharmacy, laboratory, school, and grocery (Office of Health Policy, ASPE, 2021). In such a system, patient perspectives precede care delivery, and patient needs, preferences, and values are discussed in a collaborative manner. Care providers are engaged especially in the case of vulnerable populations, complex chronic conditions, and frequent care transitions. On the data side, a care coordination approach requires information on patient preferences, social determinants of health (SDOH), and data interoperability.
Care Coordination as a Means of Supporting Value-Based Care
Care coordination leads to effective, appropriate, and safer care. Multiple approaches may be employed to achieve successful care coordination: medication management, teamwork, patient-centered medical home, care management, and health information technology (Agency for Healthcare Research and Quality, 2018). In a coordinated care system, multiple activities are supported such as accountability, communication, care transition, care planning, patient need assessment, monitoring and follow-up, aligning resources with patient and population needs, supporting patient self-management, and linking community resources.
Promotion: Case Management and Care Coordination: Supporting Children and Families to Optimal Outcomes (SpringerBriefs in Public Health) Paperback – Import, 8 August 2014 by Debbie Stubbs (Author), Janet Treadwell (Author), Jeanne W. McAllister (Author), Rebecca Perez (Author), Ruth Buzi (Author), Susan Stern (Author)
Well Designed Care Coordination Systems
Care coordination must be well-designed and targeted at the right patients to improve outcomes of providers, patients, and payers. According to the Institute of Medicine (IoM), care coordination is associated with safety, effectiveness, and efficiency. Such a design requires overcoming disjointed systems and processes occurring in primary care and specialty sites, assisting patients, primary care physicians, and specialists understand referrals and appointments, and increasing efficiency (Agency for Healthcare Research and Quality, 2018).
Quality measures define the practice of care coordination. The care coordination quality measure for primary care (CCQM-PC) can be used to make an assessment of experiences of adults in primary care settings (by administering surveys) and fill gaps in care delivery (Agency for Healthcare Research and Quality, 2018). It builds a conceptual framework allowing assessment of patient perceptions of care quality and make improvements. The written and computer-assisted telephone survey are tools to understand patient preferences regarding health care to improve the care coordination for a primary care practice (Agency for Healthcare Research and Quality, 2018). CCQM-PC is part of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of measures designed to understand the relationship between care coordination and quality and outcomes. Information from surveys has an impact on care transition, care planning, and information sharing. Care coordination may be guided by the Care Coordination Measures Atlas, which contains instruments for care coordination measures for patient centered medical home, ambulatory care, elder care, community physicians, complex pediatric needs, and chronic illness.
Coordination Strategies for Youth with Traumatic Brain Injuries
Care coordination in pediatrics spans multiple institutions and systems. In the patient-centered medical home (PCMH), care coordination encompasses compassionate and team-based care, and informed care delivery among multiple stakeholders including social workers, community partnerships, educators, healthcare workers, families, and other service providers (Palusak et al., 2022). In the pediatric population, children with special healthcare needs (CSHCN) are at a high risk of emotional, physical, developmental, and social chronic illnesses, requiring competent, comprehensive care coordination and a multidisciplinary approach. Care coordination improves patient perception of care and eliminates adverse reactions, treatment delays, care fragmentation, missed appointments, and emergency department visits.
Recent data disseminated by the Care Coordination Measures Atlas, National Health Academy for State health Policy, and Commonwealth Fund Report indicates that care coordination may improve outcomes for pediatric chronic illnesses. In this context, traumatic brain injury (TBI) is particularly relevant. TBI is a significant health burden in the pediatric population (Palusak et al., 2022). Deficits and disability following TBI may influence daily functioning and decrease in reported Quality of Life (QoL) depending on severity of injury. Coordination and standardization of care after TBI is important to achieve consistent referrals for rehabilitation and address unmet needs, caregiver stress, and adverse long-term outcomes.
Researchers carried out a scoping review to understand the impact of care coordination measures on the pediatric population post-TBI. The categories of reported outcomes included cost of care, parent and child quality of life, healthcare utilization measures, perception of care, and healthcare satisfaction. The implementation of care coordination demonstrated favorable outcomes:
- Decreased the number of inpatient days (length of stay)
- Decrease in disease-related emergency department visits
- Reduced hospitalization and readmission rates
- Increased use of outpatient services as opposed to inpatient services
- Reduced use of inappropriate and duplicate services
- Shift towards primary pediatric services as opposed to specialty care
- Increased ease of access to services, decreased barriers and wait-times
- Unmet needs of children decreased in mental health, dental care, respite care, and therapy
- Creation and utilization of care plans with the involvement of family members increased awareness and satisfaction in a few cases
- Cost of care and out-of-pocket costs showed a decline
- A decrease in disease severity and symptoms was evident
- Child QoL increased, and in some instances caregiving-related burden showed a decline (physical strain, social restriction). However, overall parental burden remained the same
- Overall satisfaction and improved caregiver perception as a result of being connected to care coordinators
Promotion: Care Coordination: A Blueprint for Action for RNs Paperback – 30 January 2018 by Gerri Lamb (Editor), Robin Newhouse (Editor)
Keywords
readmission rates, institute of mediine, value-based healthcare, trauma-informed care, care coordination measures atlas, traumatic brain injury, AHRQ, length of stay, care coordination, TBI, quality of life, QoL
References
Agency for Healthcare Research and Quality. (2018). Care Coordination. Ahrq.gov. https://www.ahrq.gov/ncepcr/care/coordination.html
Office of Health Policy, ASPE. (2021). Supporting Value-Based Care Transformation through Interoperability and Care Coordination.
Palusak, C., Shook, B., Davies, S. C., & Lundine, J. P. (2022). A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel. International Journal of Care Coordination, 205343452110706. https://doi.org/10.1177/20534345211070647
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