Cradle to Grave Care: The Holy Grail of Care Coordination.
Truly effective Care Coordination should follow us all the days of our lives.
By George Martin, MD – Senior Medical Director for Health Integrated
Care Coordination Summary
Based on the blogs of the past few weeks we have tried to rough out the functions that care coordination must accomplish. To be effective, it must be literally cradle to grave with special emphasis on life’s transitions. And it should be continuous, though not necessarily obvious.
Children need preventive medicine and preventive education. Protection against infectious diseases and anticipatory guidance to drive life style choices are equally in need. Smoking cessation would be unnecessary if one never started. Small pox, once a scourge of mankind, is now extinct (except in captivity) due to vaccination.
Young adults probably need fewer checkups and more check-ins. They should be encouraged continually to make healthy choices. Seeing a doctor for a physical exam is not likely to be of much a value.
The value proposition changes with age and the development of health issues but the need for continuity of care coordination does not. Care coordination requires a comprehensive and flexible structure. It cannot be one size fits all if it is to be successful.
Much of the care coordination function has been left to payors. Sometimes this is the insurance companies and sometimes the employer. Neither of these strategies is optimal as the likelihood of staying with either an employer or an insurance company for life is remote. Insurance contracts are reviewed annually and employment rotates on the average every five years. This leads to short term strategies to drive returns.
Thus a disease management program to improve the health of asthmatic patients is common. Such a program will decrease cost almost immediately. However a smoking cessation program that yields continuing returns for many years is all outgo with no income in the short term and any reduced cost of health care is at risk to be reaped by the next payor.
These issues suggest that the care coordination function should follow the patient and not the insurer. Similarly to the mandate that insurance should be continuous when changing jobs, care coordination should be continuous as well. Patients could be assigned to a permanent care coordination function that was funded by payors but not managed by payors. Care coordination would be a standard part of the insurance package but managed in the best interest of the patient and paid with a simple per member per month stipend.
Such care coordination would continue as long as the patient was covered by insurance. The nature of the insurance (Medicare, Medicaid or commercial) would not be immaterial. The needs of the patient would drive the resource allocation.
An interesting and potentially utopian thought perhaps. What do you think?
Thanks in advance for your input. You can reach me directly at healthexecforum@healthintegrated.com, or comment directly in the blog.
George Martin, MD
Doing a lot of pondering of the heatcare system and expense and PCMH and ACOs etc the past few weeks. The problem we have is trying to fix a failed model. Fee for service is ok for some Doctors but doesn’t serve primary care well. Expenses aren’t predictable and the business model have become embroiled in politics and the confusion has left them trying to make the best of a model that was never a good one to begin with. The best Care Coordinator is a Physician or other Priovider working with a Physican to manage the high risk problems that a patient has and might develop. We have to move to a system that values primary care properly without taking a knife to specialites that earn their keep.
Time for a new model…PCMH and Direct contracted Primary care where we eliminate admin and claims processes and replace them with them with qulaity reporting and care coordination in a format that portends success and the support to make these things happens.
With technology improvements and continuous case management procedures it’s possible that one day we could see care coordination follow the patient. Especially under the idea of assigning a long term care coordinator. Again, something that seems possible in the future. Agreed that this process need to focus on valuing primary care without cutting our specialties that are much needed.