The Tangle of Coordinated Health Care

Who coordinates the coordinators?

More specifically, who coordinates the proliferating number of health care helpers variously known as case managers, care managers, care coordinators, patient navigators or facilitators, health coaches or even — here’s a new one — “pathfinders”?

Rachel Schwartz, a licensed clinical social worker for close to 20 years, came face to face with this quandary earlier this month. Employed by a home care agency in Virginia, she visited a woman in her late 70s who had recently come home from the hospital.

The patient, who lives with her husband and daughter, has diabetes and dementia. Ms. Schwartz, during the scant one to three social work visits that Medicare will cover, planned to help her sign up for community services like Meals on Wheels.

“We’re trying to keep people at home and out of hospitals,” she said.

But the woman also had a care manager through her Medicare Advantage program, her daughter reported, handing over a business card. Not wanting to duplicate those efforts, Ms. Schwartz left the care manager a message, then later texted a former colleague who worked for the same program. Did she know this care manager? They should collaborate.