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The Growing Need for Care Coordination

This blog post excerpts an article from the Winter 2015 issue of HealthStream's PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience. 

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According to a recent report by the Centers for Medicare and Medicaid (CMS), the United States spent nearly $2.9 trillion on healthcare in 2013. Medicare accounted for 20 percent of it. That amount is expected to increase exponentially during the next 15 years due to the increased number of baby boomers who are eligible for Medicare. Ten thousand baby boomers become eligible for Medicare every day, which means that, by 2030, this generation will account for the majority of the estimated 55-percent increase in Medicare enrollment. 

This dramatic increase in the number of Medicareeligible patients puts hospitals at risk for increased costs associated with hospital readmissions. CMS estimates that one in five Medicare patients is readmitted to the hospital within 30 days of discharge, which currently costs nearly $12 billion each year. It is estimated that 40 percent of these readmissions are avoidable simply by improving care coordination and promoting service integration between healthcare settings. Since patients who experience uncoordinated care incur costs that are, on average, 75 percent greater than patients who received coordinated care, the savings to hospitals that implement these practices could be astronomical. 

Care Coordination as a Strategy to Reduce Readmissions 

Faced with mounting costs, the need to prepare for the coming storm, and the data supporting the implementation of care coordination and service integration processes, many organizations have already begun to address the need for care coordination during the 30 days following discharge. That window is critical for a couple of reasons. First, hospitals will be penalized for certain readmissions by Medicare during that period; and, second, patients are most vulnerable during that time. Many patients do not understand their diagnoses and/or treatment plans, or know the person to contact for questions or concerns. That is evident from the fact that less than half of all hospital patients (not just Medicare patients) follow up with their primary care physician within 30 days after discharge. 

Based on these trends and opportunities for significant savings, healthcare organizations are expanding their discharge processes to include care coordinators, or extensivists. Extensivists help coordinate and manage patient care plans and transitions, and improve patient outcomes through better communication between patients and providers. This coordination can be provided both directly and indirectly. Indirectly, they serve as an easily identifiable contact for patients when questions or concerns arise. Directly, they assist with patient and family understanding of treatment adherence, and help to organize care information across all settings. They also assist patients with navigating care processes across the care continuum, which is important since there are such a large number of healthcare settings that function independently, and since there is a wide variety in “protocols, standards, and information systems.” 

This article also includes:

  • Populations where care coordination is most effective
  • The urgency of action on care coordination
  • Which healthcare personnel should be responsible for care coordination

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