Care Coordination Services

Medical team working together at table in hospital

Care coordination plans are the future of healthcare. By utilizing strategies that bring community resources together, health and human service providers can offer better, more comprehensive services that save costs while improving patient outcomes.

What is a Coordinated Care Plan?

Every day, health and human service organizations across the country work to improve the healthcare outcomes of those they serve. This is not always an easy task. Healthcare has been traditionally fragmented, with critical services split up among a variety of providers.

This siloed approach often means that providers are not always able to communicate with each other, making treatments less coordinated and leaving the burden of navigating the healthcare system on the patient. For individuals reliant on social services, this task often proves to be the barrier keeping them from the most effective treatment plans.
Coordinated care plans seek to remedy these issues in fragmented healthcare. In basic terms, care coordination is the synchronized effort of health and social care providers to help a single patient receive comprehensive, integrated care. The term is used interchangeably with coordinated care.

Care coordination is the synchronized effort of health and social care providers to help a single patient receive comprehensive, integrated care.

Coordinated Care Improvements

Improvement and efficiency is at the heart of coordinated care plans. When implemented properly, care coordination can:

  • Increase patient outcomes
  • Decrease healthcare costs
  • Save patient and provider time
  • Reduce duplicate services
  • Lower the overuse of more intensive procedures 
  • Decrease preventable hospital admissions and readmissions 
  • Improve overall patient experiences 
  • Offer more comprehensive, interdisciplinary care

Accomplishing these improvements is actually quite achievable. The key to care coordination is that all providers play an active role in communicating with each other. When these lines of communication are open, it eliminates the risk of double-treatment as well as missing treatments due to assumptions of the other parties. 

Case management is a critical piece of making these improvements. By providing a single platform for all health and human services to meet on, case management ensures that care coordination plans successfully lift off and stay in motion.

Patient Care Coordination

Another component of coordinated care is that it is centered on the patient. Instead of the patient conforming to each service, the providers come together to focus on the individual.

Essential to patient care coordination is recognizing that care goes beyond traditional healthcare treatments. In other words, it requires whole person care: looking at all aspects of patient health, including non-traditional avenues. For example, someone receiving chemotherapy for cancer may also need mental or behavioral healthcare to better handle the stress of treatment. 

Coordinated care makes whole person treatment extremely easy. Providers can quickly see if their patients are receiving the additional care they need (like mental health services) and are able to follow up until the service is received. Doing so helps remedy the common issue of patients “falling through the cracks”.

Care Coordination Strategy

So how do health and human services organizations begin implementing care coordination? The strategy for care coordination comes down to community building, leader coordination, and case management. 

  1. Community Building

    Care coordination is not about establishing large multi-national networks; it is about building care systems within your own communities. As such, getting to know local organizations and other systems of care is essential to care coordination strategy. It involves asking questions like, “What resources are available? What other organizations serve the area? What roadblocks or social determinants impact those who you help?”

  2. Leader Coordination

    Once health and human service organizations have identified other resources in their community, the next step is to find leaders and coordinators to help guide the patient and communicate with providers. Having these people on your side is a powerful step in strengthening community. Together, they can help your organization reach more people as well as cooperate with other related programs. 

  3. Case Management

    The unseen hero of care coordination strategy is case management. Case management systems are platforms designed to bring care coordination to the fingertips of all patients and providers. It allows providers to share data, make notes, keep track of treatments and prescriptions, and follow up with the patient. Without effective case management, even the best planned strategies are unlikely to succeed. ClientTrack™ has been the industry-leading case management platform for over twenty years. 

What all these strategies have in common is information and communication. This is perhaps the most critical part of care coordination—learning to function not as an individual organization, but as a community.  

 

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