Last modified: June 22, 2020
Effective health care coordination between care providers helps ensure that members receive safe, high-quality care and the best possible overall experience. That’s why we help by monitoring continuity and coordination of medical care for members across settings or transitions of care. This includes changes in:
Some examples of the care coordination activities we provide are:
Controlled Substance Monitoring
Controlled substance monitoring identifies members who may benefit from having their prescription 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. Practitioners are encouraged to contact identified members to discuss and re-evaluate their overall pain management regimens and coordinate appropriate treatment, if indicated.
Timely Postpartum Care
Timely postpartum care can contribute to healthier outcomes for women after delivery. It’s also a measure of quality care. UnitedHealthcare uses HEDIS® guidelines to measure postpartum visit compliance. The standard is to have a postpartum visit on or between 21 and 56 days after delivery. UnitedHealthcare offers interventions, such as the maternity case management program, along with automated calls, which remind members to schedule their postpartum appointments after delivery.
End-Stage Renal Disease Program
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.
Diabetic Eye Exam
Regular eye exam screenings for members with diabetes may help detect diabetic retinal disease. UnitedHealthcare uses HEDIS® guidelines to measure retinal eye exam performance 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 provider and the eye care professional performing the dilated retinal exam.
Member and Practitioner Coordination of Care Survey Questions
We ask members and practitioners to provide their thoughts on coordination of care through regular surveys. The surveys give us valuable information about their experiences with communication of timely and useful information between multiple treating practitioners and care providers.
Transitions of Care
Follow-up visits after a member is discharged from the hospital should be timely, especially for members with complex care needs who are at risk for relapse and re-hospitalization. Coordination of care across settings and between practitioners has been shown to decrease hospital admission rates and adverse events, as well as increase member satisfaction.
Availability of these care coordination activities vary by health care plan. For more information, call provider relations 877-842-3210.
When a patient’s health plan and 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 that can help patients feel confident that their health care needs are being met.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).