In part two of my conversation with two nurse leaders in care coordination, we talk about the care coordination that's happening in hospitals today; the challenges for patients, families, and providers; and how to bridge the gaps between the two. We're talking with:
The following is Part II of our conversation. Part I is here.
HLM: How common now is comprehensive care coordination in hospitals and health systems?
Lamb: Increasingly so. There are a number of quality issues that have really pushed care coordination to the fore, particularly the concern about hospitalization and rehospitalization. So a lot of hospitals and health systems are really looking to integrated care coordination to assist them in reducing in reducing avoidable hospitalizations.
Probably the biggest area where we're seeing care coordination roles and processes being put into place is in transitional care. Care coordination is increasingly common, primarily in the area of transitional care, hospital-into-community setting.
I think we're seeing it more in the emerging health systems: In patient-centered medical homes and in accountable care organizations, primarily because there is a great deal of focus on making sure that services are used effectively and efficiently and quality outcomes are achieved through coordination and team work.
So we're seeing a growth in care coordination across the board… but increasingly so in new delivery systems that really are predicated on better integration, better coordination of care, and using primary care as a hub, so you're seeing more care coordination in primary care delivery systems.
New Payment Models; Better Coordination
HLM: What's missing still?
Lamb: I don't know that any part of the care continuum is being left out that this point. Some parts are newer players than others. So the hospitals really are looking at care coordination and transitional care intensively because of the link to quality and cost, outcomes, and incentive.