The Need for Care Coordination

Care coordination is not easy to achieve, but with real transformation it is possible to fix the health care system.

Most of us accept the idea that our current health care system is broken. We may not all agree that fixing it will require real transformation rather than a series of small incremental changes. I am one who thinks that real transformation is needed.

The need for coordination across the care continuum illustrates the need for transformational change. You can discharge a patient from a hospital admission with a well-developed care plan. How will that care plan get implemented when the patient returns to their home unless efforts are made to ensure that the care is coordinated by the provider(s) who assume the role of that patient’s care? If the patient’s health fails again and they need to be rehospitalized, is that a failure of care coordination? Although not always, most times it is. But where does the fault lie?

Our current approach to delivering and paying for care makes for a hard time fixing blame and holding someone accountable for the failure in care coordination. Although the fix will not be easy, it will require a transformation in the care and payment system, not just incremental change. When providers are not part of the same network, achieving cooperation is really difficult.

In a recent editorial in the April newsletter of UCSF Center for Health Professions, interim director Dr. Suinta Mutha made the point of how difficult change is even within a health system. She stated that “In this environment of volatility, uncertainty, complexity, and ambiguity, those leading change will be challenged to redefine how care is delivered and how people within their system interact to achieve improved and accountable care. The hard, everyday work for leaders requires facilitating behavior change, engaging teams and partners, bringing together clinicians and sustaining a culture of improvement and learning. Tackling this will require skills in all four domains of health care leadership: people, purpose, process, and personal.”

Care coordination is needed but achieving it will not be easy, especially if we also want to reduce health care costs. A recent Wall Street Journal article (July 16, 2013) reported on the just-released analyses of the first-year results from a key pilot program under the federal health law. “All of the 32 health systems in the so-called Pioneer Accountable Care Organization program improved patient care on quality measures.... But only 18 of the 32 managed to lower costs for the Medicare patients they treated—a major goal of the effort.” As the article pointed out, this is a 3-year project, so maybe saving money takes longer to achieve, but if the quality of care is improved then it will eventually result in lower costs. We will have to stay tuned to see if this is true.

Unless we see transformational change, I am concerned that incremental changes will only lead to care being delivered in new silos and similar problems as with our current system will appear. The fact that we have projects—such as these described in this issue of Directions in Pharmacy^TM— means that the role of the pharmacist as an essential member of the interdisciplinary team is being recognized. And the fact that some pharmacists have stepped up to the plate to work at changing what pharmacists do and where they do it speaks well for our profession. We hope you learn from the examples discussed in this issue and see how you can begin to prepare for changes in your own future.

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is interim executive director of the North Carolina Association of Pharmacists.