Care coordination v. care management

The terms “care coordination” and “care management” are often used interchangeably. In reality, though, they are considerably different. While both are obviously focused on patient care, there are varying implications in regard to billing, reimbursement, patient management tools, and patient outcomes. Yet the two activities are interconnected.

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.”

Further, the AHRQ describes care management as:

a promising team-based, patient-centered approach designed to assist patients and their support systems in managing medical conditions more effectively.

Care management is a more episodic approach that has, according to AHRQ, “emerged as a leading practice-based strategy for managing the health of populations.

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, in a move toward care management. The primary care physician actually has more control over the care management of patients, as care coordination requires the involvement of all stakeholders, including specialty providers and healthcare facilities.

The need for care coordination continues to be an important factor in patient outcomes, however. As the population ages and develops chronic or complex conditions, coordinating care between multiple providers will become even more critical to those patients’ well-being. Care management can encompass those care coordination activities. Likewise, care coordination is often included as part of the patient’s care management strategy.