Care coordination is the “it” word in health care today – it’s a new job title, a new care collaboration, and delivery paradigm – and it even encompasses the idea of travel and hospitality services, depending on who you’re asking. The problem, however, is too many people are interpreting the idea of care coordination only as it relates to moving patients between different points of care within the health ecosystem. What is missing from the dialogue is any discussion about how the business of health care happens. By Bill Reid, SVP of Product Management and Partnerships, SCI Solutions
By Bill Reid, SVP of Product Management and Partnerships, SCI Solutions
Care coordination is the “it” word in health care today – it’s a new job title, a new care collaboration, and delivery paradigm – and it even encompasses the idea of travel and hospitality services, depending on who you’re asking. The problem, however, is too many people are interpreting the idea of care coordination only as it relates to moving patients between different points of care within the health ecosystem. What is missing from the dialogue is any discussion about how the business of health care happens.
True care coordination can’t just be about clinical delivery of care to patients – it must also encompass the critical business mechanisms that facilitate and pay for these interactions. Consider orders and referrals, for example, and their importance to overall care coordination. There are many business functions that must happen in order to see these processes through and to pay for care, including insurance verifications, scheduling and other critical messaging that must happen between payers, providers and patients.
The future of care coordination will be fully integrated, including both business and clinical workflows. To achieve this true care coordination – of both the patient and the business – health systems must be linked to their community provider network. And what many hospitals and health systems aren’t considering is how to link both sides of care coordination to effectively bridge the gap with community trading partners, and ensure patients are being delivered the right care at the right time, while also capturing the outpatient revenue hospitals so desperately need via better collaboration with this community.
For most hospitals and health systems, this care coordination paradigm presents a business problem their existing IT infrastructure alone can’t support; they need additional tools to bridge their infrastructure to their community trading partners. Their electronic health records were designed to operate within the four walls of their health system, and effectively capture data in this heterogeneous environment. Sharing it, however, across this landscape – or worse, with community trading partners – has proven to be a challenge.
Bridging The Care Coordination Continuum
It is crucial for health care enterprises to leverage digital technologies that manage the business side of care coordination and link to the patient access and patient care workflows, to streamline hospital operations, while also improving patient care and driving revenue back into the health system.
CIOs are uniquely suited to help their health systems think beyond their traditional borders and coordinate patients through the system of care. In fact, given pressures faced by health systems today, managing the business side of care coordination from a technology standpoint should be the CIO’s new mandate. To do this, however, they need to think strategically about finding low-cost, low-risk solutions that complement their existing IT strategy and help connect to independent providers quickly and easily.
Forward-looking IT leaders are helping their health systems adopt cloud-based platforms designed to grow revenue across the care neighborhood, at the network level, and connect with their community trading partners. These tools are natively designed to interoperate with software used inside the enterprise boundaries. For example, Baptist Health Care, serving communities in northwest Florida and south Alabama, deployed an IT strategy to tailor its current system to match a desired workflow for specialty referrals and care coordination, addressing concerns with length of time to authorize and schedule patients and minimize network leakage.
Using a cloud-based solution that fully integrated with network physician offices, Baptist created rule-based referral screening questions to ensure patients were screened and scheduled appropriately, delivered proper preparation instructions and added to the workflow for additional follow-up – ensuring nothing fell through the care coordination cracks. The results have been considerable, with a 61 percent reduction in the average number of days from order to scheduled procedure, and a near-elimination of network leakage by ensuring procedures are scheduled in within the Baptist Health Care network. These IT leaders are putting on their business hat and finding ways to help ensure their health system will remain profitable in the long run.
Regardless if hospitals are still operating under fee-for-service models or have partially transitioned to embrace new value-based care reimbursement, they are under enormous pressure to do more with less and deliver much-needed ROI. They are also faced with new collaboration models with trading partners inside and outside of the health system. Extending IT infrastructure to community trading partners, and ensuring the delivery and coordination of patient care activities is linked to the business processes, will mean true care coordination, and ultimately better health for the patient and the health system.