CARE MANAGEMENT

Making Sense of the “Care Coordination” Landscape

AUG 5

Amid the evolution from volume-based to value-based care, much is being written regarding the importance of “care coordination” in conjunction with various regulatory and financial incentives to improve health outcomes while hopefully lowering the cost of care.

While many agree that improved coordination among providers and other stakeholders during the care delivery process should help mitigate many quality and cost drivers, there doesn’t seem to be one clear path forward to achieving it.

We’ve examined the broad population of vendors attempting to impact the care coordination challenge and while the list of companies is long and diverse, true platforms that enable care coordination in all its various practices have proven elusive.

As is very common with all forms of healthcare innovation, rather than a handful of proven and widely implemented market leaders, what we see instead is a landscape dotted with a host of competing approaches and business models that are unfolding at various rates of success with focal points spread across the diverse range of provider and managed care end markets.

This market fragmentation that is common for most areas of innovation in healthcare is perhaps further exaggerated in the context of care coordination given the central role that patient participation plays in most of the attempted solutions.  The relative importance, intensity, and duration of an individual patient’s participation in the care coordination process quite naturally varies dramatically depending upon age, health circumstances, and the availability of various commercial or government subsidized insurance.

Not surprisingly, the vendor community has aligned itself accordingly with certain key players in the mix, but rarely with enough cohesion or traction to address the entirety of the market need.

That said, we found that three foundational elements present themselves prominently in most of the market models we see taking hold: effective communication with and education of the individual patient, efficient sharing of data, and alignment of financial incentives.

To streamline our findings for this post, we are going to put aside those vendors that have aligned themselves with payers and instead focus on those that are serving the various provider communities, where we see a host of vendors working to improve communication and collaboration for the various “teams” of caregivers across the ambulatory, acute, and post-acute settings.

In addition to narrowing our initial focus to the provider community, we have also found it useful to segment vendors and their respective solutions to reflect the three primary collaborative relationships they are trying to construct and enhance:

  • Clinician to Patient: Thorough education and engagement of patients has never been more important as they take on the role of consumers and are given greater ownership over their healthcare costs and decisions.
 
  • Clinician to Clinician: CMS regulatory efforts have begun a shift to value-based systems that call for greater collaboration in planning, transitioning, and delivering care.  Increased communication among caregivers during the facilitation of care and greater exchange of patient information among the care team equips all those involved with a more comprehensive understanding of a patient’s health and enables a more holistic treatment.
 
  • Device to Clinician: As providers increasingly take on risk in the shadow of aging populations and rising diagnoses of chronic conditions, Remote Patient Monitoring (RPM) technologies and other related devices enable them to track patient health outside of their care facility and detect signs of deteriorating conditions or non-adherence behaviors before they develop into major issues or episodes. This continuous collection, transmission, and viewing of health data keeps providers engaged and powers analytics tools that can identify gaps in care, as well as a population’s highest risk patients.


In the coming weeks, we’ll publish a more detailed examination of certain provider-focused solutions that are advancing value-based care delivery efforts by improving communication in the context of these three relationships.

Until then, tell us what you think.

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Scott Tudor
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Jamie Lockhart
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Spencer Evenson