Care coordination has been successful in many cases where applied in U.S. health care, but direct association with cost containment is not necessarily one of them. Care coordination is frequently associated to cost containment, especially when discussing advanced payment models and shared savings, but the two should be considered separately, and on their own merits: care coordination is in pursuit of enhanced patient care, while cost containment is best associated with reduced spending on care opportunities. Cost containment is essentially juxtaposed to care coordination as cost containment must imply reducing provisioning of services, while care coordination increases them.
The takeaway here is not that either care coordination or cost containment should be pursued, but that both are important in achieving better patient care and lowering operating costs for your practice. In many cases, especially for rural practices, the two are related and symbiotic. In theory, cost containment can be achieved by redirecting patient services to less costly services with equivalent outcomes: reducing emergency room (ER) visits is an excellent example where patients can receive better care from visiting their primary care physician (PCP) than from visiting the ER for many situations. Effecting such a change may be difficult or impossible without the use of care coordination. The PCP may simply be too busy providing “primary care” to instill the importance of the change to those high cost patients. Having care coordination in place is where the two concepts converge, entering that magic quadrant of better patient care and lower cost of care.
Care coordination is often associated with lower costs in the romantic conversation of doing more for our patients will lead to lower costs. Economically, such an equation is impossible. But care coordination is not strictly an economic equation, it is at its foundation, a response to populations that need a higher level of care to thrive. Responding to that need is in the highest and best interest of the patient. Unfortunately, the reality of most practices does boil down to an economic equation, and for these practices the word “triage” is a familiar term. Enter health analytics and informatics. Use of advanced analytic tools such as Lightbeam Health is one of the fastest ways to reach the magic quadrant. Care coordinators are put to their best use by addressing the patients that need care the most, and simultaneously reducing the cost of care by effectively rerouting the most expensive patients to high value care opportunities and away from wasteful spending.
Is your practice engaged in care coordination? Are your care coordinators making the best use of their time and your dollars by reaching the highest cost patients who need the most care? Engage with Caravan Health’s clinical practice leadership to find out what you can do to increase your practice’s effectiveness of care.
McWilliams, J., Cost Containment and the Tale of Care Coordination, 2016, New England Journal of Medicine, 275, pp 2218-2220