Guest post by James Calanni, J.D., MBA, chief technology officer, Community Health Partnership.
As the healthcare landscape evolves, today’s community health providers are in a unique position to design new care delivery initiatives that can support healthier individuals, families, and communities, powered by adopting innovative technology tools. According to a study on factors influencing healthcare service quality, published in the International Journal of Health Policy and Management, healthcare outcomes are enhanced when patients and healthcare providers collaborate in a supportive environment.
Care coordination is a vital component in improving the delivery of patient-centered healthcare and social services. This is especially true for high-risk populations, such as those going through transitions of care and those who belong to certain populations. Transitions of care include the time period around hospital discharge or transfer to a new healthcare setting, such as a long-term care facility or home health. These transitions leave at-risk patients vulnerable to loss of continuity of healthcare.
Populations requiring additional considerations include homeless, children in foster care and patients who over-utilize the emergency department for non-emergencies, to name a few. The goal of care coordination for these populations is to anticipate needs, collaborate with all providers of services, and to coordinate the wide array of health, social and supportive services for each group. The main goal is to improve the quality of care while avoiding costly hospital admissions and re-admissions.
To help optimize critical coordination efforts, technology solutions can help the entire care team of providers in various locations collaborate across the care continuum, raising awareness of an individual’s physical, behavioral, and social factors and driving whole-person care. Organizations like Community Health Partnership (CHP) – a Colorado Springs-based collaborative of local health providers – aim to align many care management activities throughout the community.
Here are some strategies healthcare providers and organizations should consider when designing innovative care delivery initiatives:
- Develop a strategic plan to implement your organization’s goals. During the development process, consider:
- Aligning the goals around population health, and special groups that the organization would like to target for intervention, while staying open to new ideas, technologies and models that will improve the overall health of the community.
- Providing leadership with initiatives to optimize local healthcare and social services delivery, encouraging creative and top-down involvement focused on maximizing the blend of all community resources, and reducing duplicative systems.
- Focusing on improving patient engagement/activation measures by pulling together multiple community resources, which will naturally result in sustainable growth of neighborhood health.
- Integrate care coordination in the communities you serve. Identify opportunities where collaborating with other neighborhood health providers improves the health of the individual and the whole community. When healthcare organizations and community members work together to improve care outcomes, it keeps healthcare local and builds on existing infrastructure and resources to ensure the best care and the most efficient use of our dollars.
- Connect providers with a care coordination platform. Ensuring cohesiveness in all aspects of care delivery among providers can be challenging. Organizations should consider outlining the unique needs and key priorities of the health system and the communities it serves to help identify the attributes and features needed in an ideal care coordination technology. Care coordination technologies, like ClientTrack (which is the user interface or platform to populate relevant patient data to the neighborhood health providers) allow organizations to enhance workflow efficiency, collaborate across multiple agencies, measure and report outcomes, and meet complex regulatory compliance requirements. A flexible platform like this can help eliminate the need for duplicate systems and enable the organization to provide seamless and consistent care for the entire community.
Healthcare reform continues to drive communities to be accountable for delivery of timely and quality services and improve patient outcomes. We expect this pressure to accelerate as the Federal Government pushes more responsibility for healthcare down to the States. Our response at CHP has been to implement innovative models of collaboration. We are setting an example of how organizations can use technology to more effectively work together. By improving the patient experience through seamless whole-person care coordination, organizations like CHP can help physicians, behavioral health providers and hospitals improve care quality and control healthcare costs.