Care Coordination is emerging as an increasingly important element of health care delivery, particularly as payment methods move away from strictly fee-for-service, and towards performance-based pay.
One way of summarizing the changes in health care we are witnessing is to call it the “emergence of population management.” This concept has been around for some time, but it is taking center stage now, as we look at the formation of ACOs (the Accountable Care Organizations defined in the 2010 health care reform act), as well as the move towards Patient Centered Medical Homes (PCMH) at the practice level.
Yes, individual physicians take care of individual patients, usually one-at-a-time. This has been the tradition. Usually, this takes place face-to-face in the office or in the hospital, since these are the settings that are traditionally paid for by health plans – newer ways of engaging patients, such as with online web visits, have yet to gain traction among payers.
But practices take care of populations. And, with increasing weight being given to performance-based compensation, how effective medical practices are in managing the health of those assigned populations becomes more important than ever.
There are numerous domains of managing a population, all of which are part of the mix involved in performance-based compensation. Care Coordination is one of these domains. What does that mean?
Care Coordination means sharing clinical information with others who are involved in delivering care to a given patient – the hospital, other physicians, and home health agencies. In other words, Care Coordination is about interoperability, which is something we have focused commentary upon frequently.
Can Chart Sharing using a web-based EHR do the trick?
We have looked at how information exchange between institutions – hospitals, laboratories, academic institutions, etc. – will likely proceed through the hub-based strategy of traditional HIEs. However, community clinicians might use other approaches to getting clinical data to where it is needed. Direct point-to-point sending of data is one way. “Extending the platform” of a web-based EHR is another way.
Is this adequate for PCMHs and ACOs, or any other setting where a group practice or organization is responsible for the global care of a defined population? It is certainly one of several tools that could make care coordination much easier (and much less expensive).
By extending a web-based EHR used by a community physician to other physicians, or to home health nursing agencies, Chart Share messages can be shared among distinct providers on the same platform, without having to worry about the expensive and time-lag process of establishing a validated interface with a hospital-centered or regional HIE hub.
A home health agency, for example, can be created (quickly and for free) as a “practice” on the web-based EHR, and Chart Share between practices can be a vehicle to exchange the needed documentation back and forth. Any clinician who has worked with home health agencies who see their patients (e.g. after hospitalization) understands the volume of documentation that is generated, that needs to be signed, and sent back. Regardless of what systems the home health agency may use themselves, interfacing this with the community physician via web-based Chart Share might well be an improved way of coordinating this kind of care
Many scenarios can be imagined for using the “extend the platform” approach of sharing clinical information. We have a presentation at HIMSS that illustrates this method of sharing information with a hospital; we will also show how this can work to exchange information between practices.
Taking a step back, and looking at the Care Coordination issue more generally, any method of helping get clinical data back and forth between different care efforts – hospital, home health, and among office-based consultants – will add value to the picture. As health care moves toward better, more coordinated population management, and as structures (ACOs, PCMHs, etc.) need to achieve well-coordinated health care (which impacts how much they are paid), all these tools are important to consider.