- Written by Healthy
- Category: Care Team Software
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Care Coordination can be defined as the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of healthcare services.
There are many benefits of care coordination. The main ones are: Care coordination ensures claims are paid correctly by identifying the health benefits available to a Medicare beneficiary, coordinating the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first. Shares Medicare eligibility data with other payers and transmits Medicare-paid claims to supplemental insurers for secondary payment. Note: An agreement must be in place between the Benefits Coordination & Recovery Center (BCRC) and private insurance companies for the BCRC to automatically crossover claims. In the absence of an agreement, the person with Medicare is required to coordinate secondary or supplemental payment of benefits with any other insurers he or she may have in addition to Medicare.Ensures that the amount paid by plans in dual coverage situations does not exceed 100% of the total claim, to avoid duplicate payments.Accommodates all of the coordination needs of the Part D benefit. The COB process provides the True Out of Pocket (TrOOP) Facilitation Contractor and Part D Plans with the secondary, non-Medicare prescription drug coverage that it must have to facilitate payer determinations and the accurate calculation of the TrOOP expenses of beneficiaries; and allowing employers to easily participate in the Retire Drug Subsidy (RDS) program. Please click the Coordinating Prescription Drug Benefits link for additional information.
It is paramount that healthcare practitioners, researchers and hospital staff should have the right Care Coordination Tools in order to reap these benefits listed above.
A Patiecoordination teamtionteam is usually required in patient care management especially for chronic disease management as mentioned above. A patient care team is a group of physicians and caregivers from diverse fields who communicate with each other regularly about the care of a group of patients who are receiving care from them under a patient care management program.
Participants Involved in a Patient's Care: Patients, family caregivers, physicians, nurses, pharmacists, social workers, other professionals, and support staff are often involved in delivery of health care services. As care needs become more complex, the number of potential participants and relationships among participants tends to increase. For example, care of an otherwise healthy patient with uncomplicated hypertension may be effectively managed by a single primary care physician. In contrast, care for seriously mentally ill patients could typically include physicians, nurses, social workers, psychologists, and pharmacists as core team members, but might also involve occupational or recreational therapists, dietitians, and chaplains depending on the specific patient's unique needs.136 Similarly, management of care for frail community-dwelling elderly people optimally involves primary care physicians, nurse practitioners, clinic and home health nurses, social workers, occupational and physical therapists, dietitians, healthcare workers or aides, recreation therapists, and transportation workers, as evidenced by the Program of All-Inclusive Care for the Elderly (PACE).129 Regardless of the number of participants, the patient and his or her needs are highlighted in care coordination definitions from several prominent organizations.
Interdependence of Participants: Coordination for patients with complex health care needs often involves multiple participants who individually provide specialized knowledge, skills, and services*, and who together potentially provide a comprehensive, coherent, and continuous response to a patient's unique care needs.** Three vignettes in a recent policy monograph by the American College of Physicians provide concrete examples highlighting the need for highly coordinated delivery of care when multiple participants depend on each other to provide appropriate care.†