care team

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 healthcare breakthrough of the 21st century may not come in the form of a miracle drug from the pharmaceutical industry. Rather, it's more likely to emerge from the ways caregivers interact and motivate patients.

Characterizing patients as non-compliant has long been an excuse for physicians not fully engaging people, but that needs to change, according to Bruce Bagley, MD, CEO of TransforMED, an organization devoted to helping medical practices transition to the patient-centered medical home model.

The recent 90-day review of the Military Healthcare System found it  “comparable in access, quality and safety to average private-sector health care,” Defense Secretary Chuck Hagel told a press conference last week.

That was disappointing to hear for a medical system that, for decades, has described itself as overall excellent and among the best in the country. 

A recent study described 60 persons who returned to an emergency department (ED) within 9 days after being discharged from it. (The study, "Return Visits to the Emergency Department: the Patient Perspective," was published online on September 2, 2014, in Annals of Emergency Medicine.)

In most cases, that subsequent ED visit was a quest for follow-up care for the condition that had originally brought the person to the ED. Most of these patients did report having a primary-care provider they could have consulted instead.

Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER.

Brenner, a 2013 MacArthur Fellow and executive director of the Camden Coalition of Healthcare Providers, is testing this theory with a randomized controlled trial. Findings are due out in 2016.

Phoenix obstetrician Megan Cheney no longer makes hours of telephone calls on Thursday nights to report routine results of laboratory tests to waiting patients. The calls, however, still get made every week. 

The PCMH model engages providers to partner with patients to help them achieve their health goals — rather than merely treating patients when they have illnesses or injuries.

It requires an investment in time, money and a lot of work behind the scenes, but industry officials said they’re optimistic that a more coordinated approach to primary care can both cut costs in the long run and lead to healthier outcomes for patients.

Rather than a place, the PCMH is an approach to providing primary care that is patient-centered, team-based, and focused on quality and safety. It establishes the patient’s primary care physician as the fundamental coordinator of the patient’s care.

Trying to save money in health care isn’t new to Sandra Siegel, RN. A nurse with 30 years’ experience, she remembers working for a managed care company in the ’90s doing precertifications and checking hospital stays.