A patient’s care must be managed appropriately to avoid unnecessary or duplicative tests, to ensure the patient’s medications are not contraindicated, and to improve the patient’s overall health outcomes. Two activities play key roles in the patient’s care: coordination of care and care case management. They may sound very similar but are actually quite different.
Coordination of care is achieved when the primary care physician collaborates with other healthcare providers, such as specialty physicians, to ensure that all are working together for the patient’s good. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines coordination of care as “bringing together various providers and information systems to coordinate health services, patient needs, and information to help better achieve the goals of treatment and care.” SAMHSA adds that coordination of care “increases efficiency and improves clinical outcomes and patient satisfaction with care.”
The New England Journal of Medicine (NEJM) Catalyst explains that there are several elements involved in successful coordination of care:
- Easy access to a range of health care services and providers
- Good communications and effective care plan transitions between providers
- A focus on the total health care needs of the patient
- Clear and simple information that patients can understand.
Care case management is a more episodic approach. It could involve accessing a patient’s electronic health records (EHRs) between visits to ensure tests and medications are appropriate. Care case management can also involve determining if and why a patient is not following the provider’s instructions for ongoing care. In such a situation, the provider would identify factors affecting the patient’s desire and ability to engage in the healthcare program prescribed by the provider and work with the patient to overcome potential barriers.
The eHealth Initiative and Foundation (eHI) clarifies that “a comprehensive, value-based case management system should allow healthcare institutions to … construct a longitudinal record of care, including care that the patient may have received from other providers and organizations, … improve patient safety by avoiding contraindicated prescription medications, and … track in-system progress, so providers can better evaluate quality indicators and the effectiveness of treatments for both individuals and broad populations.”
Care case management can encompass coordination of care activities. Likewise, coordination of care is often included as part of the patient’s care case management strategy.