Gail Wilensky: How the pandemic created a new impetus for improved care coordination

The COVID-19 pandemic proved to be a catalyst for many significant changes in healthcare delivery. Some were intentional, representing seized opportunities to improve processes. But other changes were forced on the industry as a result of constraints imposed by the pandemic. One of the most significant of these changes, for example, has been the industry’s rapid increase in reliance on digital health, which promises to be a pivotal tool for improving care coordination (see the sidebar below).

The post-COVID environment has presented an unprecedented opportunity to achieve well-coordinated care through enhanced communication among providers. Finance leaders should be strong advocates for embracing this opportunity because effective care coordination has been shown to be essential for the delivery of safe, effective healthcare. The focus on safety has increased with the growing complexity of healthcare services, which has required more extensive communication and handoffs among various providers, thereby raising the risks associated with the poorly coordinated healthcare delivery.

Supporting this position is clear evidence that poor communication can produce undesirable consequences. The Joint Commission reported as recently as 2018 that 80% of hospital adverse events have been linked to poor communications in the form of inadequate handovers of patients between providers and provider locations, making poor communications a leading cause of undesirable health outcomes.^a

Action needed to improve care and reduce its cost

In recent years, the concept of care coordination has been at the forefront of the ongoing transformation in how care is delivered.^b Pursuing improvement strategies in this area may be the most effective means for slowing the rate of increases in healthcare cost without sacrificing improvements in quality. Further, well-designed and executed strategies could go beyond just reducing costs to achieve significant improvements in the quality of care delivery.

For these reasons alone, health systems should adopt value-based care (VBC) strategies, given their inherent focus on improving care coordination. But to ensure the success of VBC approaches, providers must make many changes to their traditional practices, including rethinking how they communicate with each other and with patients and their families. Digital health will play an important role, but how it is used for communication is the fundamental concern.

Organizations that call for such changes are likely to encounter some clinician resistance. But as clinicians begin to experience the improvements in provider-to-provider communication, organizations are likely to reap benefits of increased clinical effectiveness and job satisfaction, as well as improved patient satisfaction.

Keys to an effective strategy

As providers develop their communication strategy, it is important that they understand which strategies are supported by convincing empirical evidence of their effectiveness in improving communication.

For example, a clinician’s commitment to showing respect for each patient is a critical factor in the clinician-patient relationship.^c  Clinicians should not only respect a person’s personal preferences and lifestyle choices in addition to their care choices, but also not allow their biases (e.g., racial, gender, obesity) to affect the quality of care they deliver.

Clinicians likewise should understand the types of requests of patients that are likely to increase barriers between themselves and a patient or the patient’s family. Many patients may resist disclosing sensitive or intimate information to clinicians who they do not know, for example. And patients may part ways with a practice if they perceive any sense of disrespect, either by the clinician or the clinician’s staff.

Fundamentally, healthcare organizations should always keep in mind the essential characteristics of effective communication, which include being timely, clear and bidirectional (i.e., allowing for a reciprocal exchange). 

Another important consideration for organizations in developing a communication strategy is ensuring that the strategy — including the approach to data storage — is HIPAA compliant. This concern is especially important in choosing a secure texting system. Cybersecurity attacks have meant that many commercially available messaging platforms are no longer viable options. There are, however, several secure instant messaging services currently available on the market (e.g., IMS Chat, OptimizeRX, OhMD and CometChat).

Avoidable consequences

Failure in care coordination is not just a problem of poor patient-provider communication. A 2019 study found that care coordination results in $27 billion to $78 billion in unnecessary care — amounting to 3.5% to 8% of total healthcare spend.^d  Improving care coordination and patient communications may not solve all the nation’s challenges related to excessive healthcare spending. But by embracing digital health while maintaining an ongoing commitment to a care coordination strategy, healthcare leaders can make headway not only in reducing spending but also in improving patient care.

Footnotes

a. Joint Commission International, Communicating clearly and effectively to patients, white paper, 2018.
b. See, for example, Hut, N., “Healthcare leaders view care coordination as an increasingly vital investment, survey finds,” HFMA, Dec. 13, 2019.
c. See, for example, James, T.A., “Setting the stage: Why health care needs a culture of respect,” Harvard Medical School, Aug. 31, 2018.
d. Moscovitch, B., “Improved provider coordination can reduce health care costs,” Pew, Dec. 9, 2019.

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The role of digital health in improving care coordination

As a result of their increasing adoption of digital health strategies, healthcare organizations are benefiting from the ways digital technologies are improving care coordination among providers and communications between patients and providers — both of which are essential goals for the industry.

As defined by the Health Information and Management Systems Society (HIMSS), “Digital health connects and empowers people and populations to manage health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable and digitally enabled care environments that strategically leverage digital tools, technologies and services to transform care delivery.”^a

The pandemic elevated digital health to the point where it could begin to profoundly transform the way healthcare is organized and delivered. The change was a response to the need for patients to be able to connect with their providers to receive care when in-person visits were not possible for them. It might have occurred without the onset of COVID, but the pandemic accelerated adoption of digital health far beyond anyone’s expectations. What is important about this development, however, is its capacity for helping the industry address the fundamental challenge of ensuring care is well coordinated.

Footnote

a. Snowdon, A., “HIMSS defines digital health for the global healthcare industry,” HIMSS, March 2, 2020.

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