Coordination - Short Take on Coordinating Care

What – Article by Thomas Bodenheimer, MD, West Coast managed care expert – “Coordinating Care – A Perilous Journey through the Health Care System, “ New England Journal of Medicine, March 6, 2008

Why - Because more and more Americans are falling through the cracks, shuttling back and forth between specialists. Bodenheim says barriers to “seamless coordination” are – overstressed primary care physicians, shortage of primary care doctors, lack of interoperable computer systems, low primary care pay, no payment for coordination, and paucity of integrated systems.

When – Poor coordination has been a problem for at least 20 years, and has grown more intense over the last decade with physician shortages, widening income gaps between primary care doctors and specialists, and lack of incentives to coordinate care.

How – To correct coordination deficiencies, Bodenheimer suggests electronic referrals by primary care doctors to specialists, referral agreements between the two, hospitalist-initiated agreements with practitioners, advanced practice nursing, care transition programs, and assisting primary care clinicians through: 1) transforming solo practices into “teamlets” – two person teams with a physician and non-physician coordinator in each practice; 2) payments for coordination; 3) creating “medical homes,” 4) adopting and subsidizing EMRs and interoperable records; 5) moving primary care into larger integrated systems.

Where - Wherever different health care entities choose to work together or to integrate into organizations..

Who – As a practical matter, coordinating care is most talked about and acted up by leaders of large integrated systems, which involve about 12% of American physicians, some of which are physician-led and others hospital-led. American Academy of Family Practice, American College of Physicians, and American Academy of Pediatrics support the concept of medical homes, which visualize primary care physicians as coordinating quarterbacks for care.