07/2019: Helping Coordinate Patient Care
Effective health care coordination between health care providers helps ensure that patients receive safe, high-quality care. To help you coordinate care so patients can live healthier lives, we monitor continuity and coordination of medical care for members across settings and transitions of care, including changes in:
- Management of care between practitioners
- Heath care settings, including inpatient and ambulatory locations
- Practitioners partnering to provide ongoing care for a member
Here are some examples of the care coordination activities we provide.
Controlled substance monitoring identifies members who may benefit from having their opioid pain management regimens reviewed and evaluated by their health care practitioner. Through this program, care providers receive a comprehensive member-specific report that includes the clinical issue of concern, prescription utilization details for the medications involved and recommended action. You’re encouraged to contact identified members to discuss and re-evaluate their opioid pain management regimens and to coordinate appropriate treatment, if indicated.
Timely postpartum care can contribute to healthier outcomes for women after delivery and is a measure of quality care. UnitedHealthcare uses Healthcare Effectiveness Data and Information Set (HEDIS®) measurement guidelines to measure postpartum visit compliance. The standard is a postpartum visit on or between 21 and 56 days after delivery. UnitedHealthcare offers the Healthy First Steps Program, which is a maternity case management program, and automated calls from Silverlink, to remind members to schedule their postpartum appointments after delivery.
This program is designed to improve clinical outcomes for members with end-stage renal disease (ESRD) by coordinating care between practitioners to manage members’ comorbid conditions, as well as dialysis therapy to improve continuity and clinical outcomes. The program focuses on reducing inpatient hospitalizations, emergency room visits and mortality, while improving quality of life.
Regular eye exam screenings for members with diabetes may help detect diabetic retinal disease. UnitedHealthcare uses HEDIS® measurement guidelines to measure retinal eye exams for members ages 18-75 with type 1 and type 2 diabetes. Continuity and coordination of medical care is monitored through communication between the member’s primary care physician and the eye care professional performing the dilated retinal exam.
We ask members and practitioners to provide their thoughts on coordination of care through regular surveys. The surveys give us valuable information about their experience with communication of timely and useful information between multiple treating practitioners and care providers.
Follow-up visits after a patient is discharged from the hospital should be timely, especially for members with complex care needs who are at risk for relapse and re-hospitalization, and lack a clear transition of care. Studies show that “early consultations with a practitioner after discharge can reduce the 28-day readmission risk by almost 50 percent.”*
*Bricard, D. & Or, Z. Eur J Health Econ (2019). Retrieved from https://doi.org/10.1007/s10198-018-1022-y
Why is it important to focus on care coordination?
When a patient’s health plan and all of their care providers work together closely, it can help increase the chances they’re receiving the safest, highest quality of care possible. Here are some simple ideas for you and your team to consider to help patients feel confident their health care needs are being met.
- Get the complete picture. Ask your patients to sign an authorization form so you can get their medical records from other clinics or care providers. Remind them to bring in health care paperwork from other specialists, as well as all medications and over-the-counter drugs.
- Explain recommended tests and pass along results promptly. Thoroughly explain any recommended tests your patient needs. Let them know when and how you’ll share their results. When you discuss results, be sure to flag any follow-up care that’s needed. If there are any delays in getting the results, proactively let your patient know.
- Ask patients for their support. Tell your patients you want to be involved in all aspects of their care. Request they let you know about any off-site tests and visits to a specialist, urgent care or emergency room.
- Schedule appointments. If required, print out a referral form to help your patients schedule their follow-up appointments. Offer to schedule their next check-up visit before they leave your office.
- Encourage information sharing. Remind your patients to give your contact information to any other specialists they see. Give them a business card to make this even easier.