April 30, 2009
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While there was no single recipe for coordination given the variety of patient, physician, practice and market factors, the study identified cross-cutting lessons, such as the value of a commitment to interpersonal continuity of care with a clinician as a foundation for coordination. Other strategies ranged from restricting patient panel sizes to formalized agreements between primary care physicians and specialists about how to handle referrals and consultations, including timely access to specialists and what information should be shared between the practices.
Based on in-depth interviews with national experts and physicians in 36 physician practices, the study also identified the importance of system support for the standardization of office processes to foster care coordination. While larger practices may have more resources to invest, many of the innovations described could be scaled to smaller practices, according to the study, which was supported under a grant from the Robert Wood Johnson Foundations Health Care Financing and Organization Initiative, which is administered by AcademyHealth.
Respondents were quick to note that existing fee-for-service payment does not reimburse care coordination efforts. Because there are no payments for such activities as following up on referrals or communicating with patients outside of the office, physicians do so at the expense of other, billable activities, according to the study.
"If aligned with payment incentives, some of these strategies have the potential to increase quality and satisfaction among patients and providers by helping to move the health care delivery system toward better coordinated care," said HSC Senior Researcher Ann S. OMalley, M.D., M.P.H. coauthor of the study with former HSC Health Researcher Ann Tynan, M.P.H.; Genna R. Cohen, HSC health research assistant; Nicole Kemper, HSC health research analyst; and Matthew M. Davis, M.D., of the University of Michigan.
The studys findings are detailed in a new HSC Research BriefCoordination
of Care by Primary Care Practices: Strategies, Lessons and Implicationsavailable
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.