Coordinating a patient’s care properly can mean the difference in that patient’s healthcare outcomes. The primary care physician, in particular, must be able to coordinate care for patients who are seeing multiple providers, undergoing tests, or staying in healthcare facilities for treatment of chronic or complex illnesses. This type of care coordination is not the same as case management.
The Case Management Society of America (CMSA) defines case management as “provided by healthcare professionals working with people to identify issues and barriers that may prevent them from getting better and uncovering mutually agreed upon solutions to achieve their healthcare goals.”
The Agency for Healthcare Research and Quality (AHRQ) describes care coordination as “deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.” The AHRQ emphasizes that care coordination necessitates communicating the patient’s needs and preferences at “the right time to the right people.” The information must be shared and used in a secure manner and in a way that provides “effective care to the patient.”
Care coordination’s main goal, as the AHRQ defines it, “is to meet patients’ needs and preferences in the delivery of high-quality, high-value health care.” Given the shift toward value-based reimbursement structures, independent physicians are investing in tools that help them more effectively direct their efforts toward the specific and immediate needs of their patients.
Similar to and working with the primary care physician’s care coordination efforts, CMSA states that case management is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.”
Further, case management “helps identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value” for patient, payer, and provider.