Care coordination provides intensive, individualized services to patients that are managing multiple medical conditions by helping them navigate the health care system and coordinate services among their various providers (doctors, nurse practitioners, physician assistants, nurses, a psychotherapist, social worker and pharmacist).

It is recommended for patients faced with a high-risk, high-cost diagnosis, comorbidities, or those transitioning between facilities or to their home to enrol in a care coordination program, New York City, which will not just ensure their wellbeing, but prevent unnecessary Emergency Department visits and hospitalizations as well. This practice benefits patients and their families, healthcare providers, payer organizations, and population health efforts. The main goal of such a program is to meet needs of patients and their preferences in the delivery of high-quality, high-value health care. The practice allows patients’ needs and preferences to be communicated at the right time to the right people, and that this information acts as a guide in the delivery of safe, appropriate, and effective care.

The positive impact of care coordination on patients, their caregivers, is what has led to the popularity of the programs. The main goal of the programs is to simplify the experience for patients and focus on their individual health goals. Many patients have marvelled at how much their joining a program has helped with their health conditions, from adjusting their medications to changing diet to exploring clinical trials they might benefit from.

The benefits of care coordination:

When care coordination is done right, it not only improves the patient’s experience of care, it also improves a patient’s long-term health and cuts down costs. It can mean a variety of different things, but mainly, it is a patient-centered approach that strives to meet the needs and preferences of patients, with the type of coordination required depending upon factors like the complexity of a patient’s medical condition, one’s level of education, their access to resources (such as things like stable housing and transportation), and the level of ongoing care that will be required at home, thus helping to strengthen the caregiving capabilities of families and service providers.

The main characteristics of care coordination include

1. Collaboration between all members of a care team, regardless of their specialty, role or location
2. An open communication channel between all parties in charge of a patient (effective and timely communication between members of a care team, mainly including the patient/patient’s caregiver)
3. Helps in avoiding unnecessary tests and procedures, thus helping to improve the care experience while reducing the costs
4. Examining all of a patient’s needs, not only their immediate clinical needs

Remember care coordination isn’t one-size-fits-all, what’s right for one patient may not necessarily be right for another- it all boils down to delivery of the right care in the right place at the right time. Patients may as well be assigned a coordinator to help coordinate care.

Significance:

Improving Patient Outcomes- For healthcare providers, coordinating care for patients after their hospital discharge is one of the most challenging tasks. It is a huge responsibility on a hospital to not just ensure that a patient is ready for discharge, but they must as well reach out to patients multiple times after discharge to ensure they are following through on their plan.

With coordination programs in place, post-discharge hospitals can reduce avoidable readmissions, improve compliance, and ensure a patient’s well being by bridging any gaps that may prevent patients from staying on the path to recovery.

Improving Providers’ Delivery of Care- Care coordination promotes cooperation and information-sharing between multiple providers and specialists in charge of a patient, thereby reducing fragmentation all through care, and also helps build trust between the patient and their care team. Everyone on the team is on the same page about the next steps in the patient’s care plan. The practice helps patients approach their care the way they want, even with end of life planning.

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