Looking for examples of care coordination in action? There are many ways that health care providers can improve outcomes for patients through a variety of resources and health care services. Care coordination works when multiple providers and patients collaborate to implement safe, appropriate, and effective care transitions.
Care coordination is a key component of effective health care delivery, and it can have many benefits for patients, multidisciplinary teams, and primary care providers as they align resources in their care plans.
Since care coordination is such a vital component of modern health care, it's helpful to streamline patient care and ensure that all participants are working toward the same goal of improved outcomes and high value. Whether it's using technology to improve communication between health care providers, or creating targeted care plans based on each individual's unique needs, there are countless examples of care coordination in action that can help to improve the quality and efficiency of health care delivery for a patient's needs and preferences.
Examples of Care Coordination for Improved Health Outcomes
Examples of care coordination include developing a plan for how a patient's care will be managed, communicating with all of the numerous participants who are caring for a patient, and making sure that patients receive the services they need in a timely manner.
To fulfill these goals, innovative care coordination initiatives have been created, such as large-scale telehealth programs that allow patients to connect with their doctors from the comfort of home; patient-centered care initiatives that focus on empowering patients to take an active role in their own health care decisions; and collaborative care models that bring together different health care providers to work as a team to provide the best possible patient care. These models aim to improve health care delivery through patient care activities, medication management, and other services delivered for a patient's improved quality of life.
Telehealth and Telemonitoring Programs
Telehealth and telemonitoring programs in care coordination allow care providers to monitor patients remotely, often via web-based or mobile applications. Using this approach, health care providers and care coordinators can detect potential health issues earlier and provide timely interventions, resulting in better patient outcomes. By using remote technology, providers such as primary care physicians and specialists are able to assist patients without the need for clinic or hospital visits, enabling better care delivery in complex care plans.
Patient-centered Medical Homes
The patient-centered medical home model in care coordination uses multi-disciplinary teams to provide coordinated care for patients with chronic diseases and conditions such as diabetes or heart disease. This approach has been shown to improve outcomes and reduce costs while enhancing patient satisfaction. Organizing care involves medication management, follow-up visits, care delivery, and other resources within a team to provide specialty care for patients in their homes.
Shared Care Planning
Shared care planning models, such as the Southampton Care Model, involve health care providers and patients developing a coordinated care plan together. This approach allows patients to have greater input into their treatment decisions, while also ensuring that they receive appropriate care at all stages of their condition. Shared care planning in care coordination is focused on patient needs for chronic care management through a combination of resources to improve health outcomes.
Who is responsible for coordinating care?
There is no one-size-fits-all answer to this question, as the responsibility for coordinating care will vary depending on the specific situation. In some cases, a primary care physician may be responsible for coordinating care. In other cases, a hospital or health care system may have a designated care coordinator or care team who is responsible for overseeing the care of all patients within the system.
What are some examples of care coordination activities?
Some examples of activities that can fall under the umbrella of care coordination include:
-
Ensuring that all members of a patient's health care team are aware of the patient's needs and are working together to provide the best possible care.
-
Helping patients navigate the health care system and connect with the resources they need.
-
Providing education to patients and their families about their health conditions and treatment options.
-
Assisting with discharge planning to ensure that patients have everything they need to successfully transition back to their homes and communities after a hospital stay.
What are some challenges associated with care coordination?
While there are many benefits associated with care coordination, practitioners can also face difficulties, some of which include:
-
Educating patients and their families about their health conditions and treatment options. Not everyone will have the same level of understanding or knowledge about their condition, and some people may be reluctant to accept new information about their health condition or treatment options.
-
Connecting patients with the resources they need. Patients may not be aware of all of the resources available to them or may not have transportation to access these resources.
-
Ensuring that all members of a patient's health care team are aware of the patient's needs and are working together to provide the best possible care. This can be especially challenging if team members are located in different facilities or across different geographical areas.
Using Technology in Care Coordination and Health Care Services
In today's complex health care landscape, the challenges just mentioned are often magnified as providers struggle to keep up with ever-increasing demand and time-consuming regulatory requirements. Providers need the help of automation, consolidation, and analytical insights that technology provides to streamline workflows associated with care coordination.
Forcura, a cloud-based, healthcare workflow management company, assists home-based care organizations with workflow management solutions that help them improve outcomes and operate more efficiently both from the office and the field. Partnering with more than 800 clients, Forcura and its technology platform facilitates value-based care and care team collaboration, contributing to more than half a million patients each month experiencing less friction and more positive results in their care. Like the home health, hospice, personal care, and other clients we serve, we believe the role of patients in coordinating care should be easy so that the only thing they need to focus on is their health.
If you are a home-based care organization struggling with some of these challenges, let us help make the care coordination process easier for you so that your team can provide the highest quality of care to your patients. For more information, check out Forcura today!
