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Improving Care Coordination

by Jennifer Johengen-Vogel, MS, RN

Vice President, Health Management

Date:
May 22, 2019

Care coordination has become fundamental in health care today, and it’s something I’m passionate about. As a registered nurse who has worked in a variety of care settings, I’ve seen the difference it can make for patients and practices – whether it’s well or poorly handled.

Here are five proven steps your office can take to support holistic care for your patients, and your reimbursement in value-based programs.

Identify an office champion

Designate a member of your team to champion care coordination and engage your office. This is particularly important for patients dealing with complex medical conditions, or who have recently been discharged from acute care. This champion can drive your efforts by ensuring exchange of information and forming agreement on responsibility and accountability among the providers involved in a patient’s care.

Engage patients in shared decision-making

Utilize motivational interviewing with patients to understand a patient’s goals and perceived barriers. Understanding your patients’ circumstances and what motivates them can create a collaborative relationship and improve compliance. 

Standardize your approach

Establish pre-visit planning to ensure all tests are done prior to appointments. Standardize follow-up, and schedule appointments in advance. Consider creating patient registries using your electronic medical record (EMR) or claims data to help target patient outreach.

Employ technology

Patient portals, apps and secure text messaging can remind patients about upcoming appointments or tests, offer medication reminders, and provide lifestyle tips.

Utilize available resources

Your BlueShield patients are eligible for our population health management programs, including asthma, cardiac, depression/substance use, diabetes, oncology, and more. We can serve as an extension of your office through our team of pharmacists, social workers, dieticians, behavioral health specialists, and other health professionals. Please call us at 1-877-878-8785, or click here for more information about our 2019 programs.

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