Coordinating Care – Are Physicians Ready?

February 4, 2016 · NCQA Communications

Coordinating Care

Coordinating Care

For the well-being of patients and pocketbooks, the U.S. health care system is shifting to coordinating care.  That is value-based, primary care focused on the whole patient.

It can be a hard transition for some primary care physicians.  According to a study in The Commonwealth Fund, almost one-quarter of U.S. primary care physicians surveyed said they are not prepared to manage and coordinate care for patients with complex health care needs and severe mental illness.

In the February issue of Value-Based Care News, reporter Angela Mass takes a deeper look at this issue.  She spoke with NCQA‘s Michael Barr, M.D. Executive Vice President, Quality Measurement and Research Group who says medically complex patients have different types of issues that sometimes overlap.  He adds that mental health issues can be contributors to chronic conditions and conversely, people with multiple chronic conditions can develop mental health issues because of those conditions.

Mass finds in many cases, the resources are not there yet to coordinate care across the board for every patient.  “With so many care providers potentially involved in one person’s care, it’s critical that there is seamless communication among them,” writes Mass.

The Shift to Coordinating Care

Barr says patient-centered medical homes and accountable care organizations are making care more organized through a group health approach. A patient-centered medical home can provide a road-map to practices from the simplest to the most complex patient.

The U.S. health system is moving from the “let’s get a prescription and fix the problem culture” to tying primary care with understanding patients’ lifestyles.  This means managing care by addressing factors such as nutrition and exercise to help prevent or eliminate patients’ chronic conditions.

R.W. Watkins, M.D., senior physician consultant for the NCQA accredited Community Care of North Carolina, says they use electronic health records which helps physicians to identify at-risk patients such diabetic patients who haven’t been into the physician’s office in six months. That information allows the practice to contact those people and schedule them for checkups.

David Ehrenberger, M.D., chief medical officer for Avista Adventist Hospital and Integrated Physician Network says coordinated care management codes now are available for patient-centered medical homes.  And adds that a per-member per-month management fee can fund the extra work required in order to effectively coordinate care.

Mass finds this paradigm shift from fee-for service to value of care is slow going, but the health care system is moving in that direction.

VBC Article 1.29.16

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