Delivering Better Care Through Better Coordination

Care coordination shouldn’t just be another buzzword; it should be the foundation of all healthcare providers’ strategies to delivering integrated, holistic and quality services. In a recent webinar, Delivering Better Care Through Better Coordination, panelists discussed the importance of care coordination, as well as strategies, techniques and technologies to achieve seamless transitions of care based on several real use case examples.  

Panelists included Senior Associate at OPEN MINDS Sharon Hicks, MDA, MSW; Director of Information Technology at Lutheran Senior Services Michael George, RN, BSN; Senior Vice President of Clinical Operations at CPC Behavioral Healthcare Donna Coyle, LCSW, LCADC, CCS, CPRP; and Vice President of Interoperability at Netsmart AJ Peterson. 

Here are a few highlights from the webinar. 

Importance of person-centered care (1:30) When looking at holistic views of a person and considering their physical, behavioral and social aspects of care, how does that drive outcomes, decrease costs and create a better experience for not only the consumer, but also for the provider and staff as well. What is the current landscaping around transitions of care? Why is person-centered care important? 

Information at the point of care (22:00) How individuals access care today is often through disparate provider networks. The need around data sharing and interoperability has never been more important than it is now. Providers who are seeing individuals for the first time need access to data at the point of care so they can have a comprehensive view of that person, allowing them to make the best clinical decision possible. Then also making sure they're coordinating the care back into the appropriate setting, making sure that the health data follows the consumer.

Eliminating siloed data (30:00) When thinking about missing or siloed data, living in the world of paper fax is antiquated and not conducive to an efficient and accurate clinical workflow. LSS has invested a lot in technology to really help drive clinical decision support and provide insights to clinicians and providers. They do that by making sure that they have usable and readily available data. When there is missing or siloed data, it adds a challenge or barrier to transition of care.

Major time savings (43:00) It was taking anywhere from five to 10 minutes per resident for health information coordinators to upload paper documentation to the EHR, depending on the number of documents. With the Carequality workflow, LSS staff can do that in less than a minute. That has saved not only time for health information coordinators, but it has improved the availability of that documentation for bedside coworkers to have that in the moment. Also, admission coding is completed within 24 hours of an admission, where prior to this it was 72 hours.

Key ingredients of an integrated care model (52:00) It’s really about the team working together. Medical providers, case managers, social workers and nurses need to collaborate to determine exactly what the client needs. CPC has an in-house pharmacy. So, in addition to having electronic charts, the in-house pharmacy also has access to the EHR. The pharmacy is able to coordinate physical health and mental health medications for the person. Alerts are received when somebody is due for medication and if they haven't picked it up from the pharmacy yet. Providers can intervene with that individual and work together to make sure that they get their medication and they don't end up in the ER because they forgot to pick up their prescription.  

Removing barriers through technology (1:00:30) Now more than ever, providers are being asked to do more. Technology is enabling them to do their jobs, not becoming a barrier. It’s important to look at how to use these tools in order to remove friction from a provider perspective to drive efficiency. Boosting provider satisfaction and enabling them to do their jobs better is it ultimately the key.

Where do we go from here? (1:23:30) First, providers should look at the data they have and determine what information is most important for hospitals, doctor's offices, other points of care in order to make more informed care decisions. Then, have meaningful conversations to discuss what data or other documentation they may want to see but is not currently being offered. It’s also not just about the information they could send—what can be sent to them? That way, it becomes shared. It comes down to building relationships with other providers and organizations so that everyone can work together.

Watch Delivering Better Care Through Better Coordination now. Don’t miss the great Q&A session at the end!