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HomeHealthCare Coordination Through Local Partnerships: A Needed Policy Paradigm

Care Coordination Through Local Partnerships: A Needed Policy Paradigm

Coordination of care is essential to improving a fragmented health system. Value-based payment models such as responsible care organizations and bulk payments encourage providers to coordinate patient care between clinicians and care settings. Dedicated billing codes seek to do the same for chronic disease and post-hospital discharge transitions. Providers have increasingly implemented population health and care management programs to coordinate services to populations, especially those at high risk of frequent health care use and poor outcomes.

However, enthusiasm for the coordination of care has not historically translated into improved results. This can be explained in part by the variability in how provider organizations define and engage target populations. In addition, care coordination initiatives may vary depending on their goal and scope, including whether to go beyond clinical factors to address the social determinants of health.

Ultimately, improving the coordination of care will require policy paradigms that emphasize the formation of local provider-community partnerships that meet the social and clinical needs of populations.

While providers may attempt to coordinate care for patients using fully in-house infrastructure and staff, this approach requires substantial resources that many provider organizations simply do not have. This internal approach to care coordination can also be particularly difficult to promote in the absence of supporting incentives, such as potential payments per recipient. Alternatively, providers can make improvements by bringing in outside companies to support coordination through data, patient awareness and tracking, and technology platforms. But outsourcing services can inadvertently prevent organizations from developing the internal capabilities that are increasingly needed in a value-based environment. Critically, both the internal approach and the external partner paradigm may not incorporate the local expertise that enables care coordination.

Because this expertise often already exists in communities, leaders can support local partnership as an alternative care coordination paradigm. By working with local community partners, providers can cover the costs and extend the impact of their care coordination programs through joint investments and complementary expertise. By partnering with groups that focus on the same populations, providers can increase the likelihood that coordination will be based on knowledge of community needs and, over time, the trust and relationships needed to coordinate meaningfully. care and address the clinical and social determinants of health.

Here in western Washington, UW Medicine | Valley Medical Center (VMC) has taken this approach and recently formed a new partnership with the Puget Sound Regional Fire Authority to coordinate care for community members who frequently use firefighters for non-emergency health needs. Established nine months ago, the program involves the work of VMC and the Fire Department to identify high-risk community members; dedicated screening for social risk factors using a validated instrument; referral to community resources to address non-health care needs, such as food insecurity, which are often rooted in broader social determinants; and integration into VMC’s management of care program.

This collaboration illustrates several ways of applying a local partnership paradigm to the policy and practice of care coordination. First, policy makers can encourage the exploration of local partnerships by using the policy to highlight existing areas of need. Local groups often have local expertise as they already play a key role in meeting the health needs of the community. For example, prior to its partnership with Valley Medical Center, the Puget Sound Fire Authority was already sorting out needs and transporting community members to alternative care sites, such as doctors or emergency care clinics, for referrals. social or non-urgent health needs.

Of course, payment and care delivery models already measure and incentivize reducing unnecessary acute care use. But the models could be strengthened by a policy targeting the underlying drivers – in the case of the VMC-Fire Authority partnership, the demand for non-emergency or social services through emergency responders that resulted in sub-optimal coordination. Policy strategies include integrating a focus on local partnership into existing models, such as those created for emergency triage and transport, or by targeting key drivers within larger population-based models such as responsible care organizations.

Second, policy makers can use policy to encourage local partnerships between groups with demonstrated experience in coordinating care and responding to social and / or clinical needs within communities. For example, the partnership between VMC and Puget Sound Fire Authority was based on existing experience on both sides – for VMC, participation in Medicare Shared Savings and Bundled Payments for Care Improvement-Advanced programs; for the fire authority, working to meet the needs of the community through its own existing program.

A political option would be to use an approach similar to that adopted for some responsible care organization models by creating models and allowing only experienced groups to join and participate in them. Another would be to adopt methods similar to those used in some first aid models, creating programs with multiple ‘tracks’ through which experienced groups can join together voluntarily and take greater responsibility for coordination and results.

For many organizations, local partnerships are likely to be additions – not replacements – to other methods of delivering care coordination services. In all partnerships, the definition of role and responsibility must be clearly defined. Nonetheless, it is clearly possible to improve population outcomes through efforts to coordinate care. One way is to use the policy to encourage care coordination approaches that incorporate the local mission and expertise of care providers and community partners.

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