Ushering in the Next Generation of Care Coordination

Posted by Kyle Salem, Ph.D. on 7/25/16 1:36 PM

Find me on:

The extent of a hospital’s reach is changing. As the industry shifts towards value-basednursing-home-chart.jpg care, hospitals and health systems must think beyond its walls and work to coordinate care across the continuum, so patients can smoothly transition to the next care setting—until they ultimately return to wellness.

Until now, care coordination has been an incredibly inefficient process. Although most hospitals are adept at managing care within their organizations, it becomes more difficult when looking past the hospital setting. The problem is hospitals don’t have consistent and reliable methods for communicating with post-acute facilities and monitoring patient care. This is especially troubling because hospitals are being asked to take on more financial responsibility for patient outcomes after patients are discharged. Programs like the Comprehensive Joint Replacement (CJR) initiative from the Centers for Medicare & Medicaid Services (CMS) now require hospitals to coordinate care, signaling CMS is comfortable making these organizations the center of gravity for patient outcomes.

To overcome these challenges, hospitals and health systems must build relationships with post-acute providers, creating engaged networks and then managing them through data-driven processes. Network providers should offer a specific set of capabilities—both clinical and quality of life—and the hospital should have a streamlined method for matching patients with the right locations. Additionally, the network should include more than just nursing homes and long-term care facilities. It should also contain home care providers, social service agencies and other entities that will help individuals effectively recover. 

The reality is that getting patients to the lowest-cost, clinically-appropriate care setting quickly and safely matters. As health systems find ways to connect people to the most suitable resources and communicate with those providers throughout the care episode, they will see cost and risk reduction as well as better clinical results.

Ensocare is committed to developing tools that help hospitals and health systems break down barriers between settings. These solutions not only assist with patient placement but also assess risk and support appropriate and timely communication to improve patient outcomes and preserve the bottom line.

To learn more, listen to my recent interview with intrepidNow discussing valuable insights and challenges facing the ever expanding healthcare technology market.

Topics: Care Coordination, Care Transitions