How care coordinators could play both a clinically and fiscally effective role
Healthcare delivery is usually discussed in broad, dramatic strokes: open heart surgeries, organ transplants, cancer patient survival rates, etc. But seemingly insignificant things can dramatically impact healthcare delivery. For example, a patient misses a crucial doctor’s appointment because they lack transportation, leading to another hospital stay. Or a patient with diabetes lets their health slip to a dangerous level because of depression or denial, leading to an amputation or blindness.
Given the number of Americans with chronic healthcare conditions, these missed connections or lack of self-management add up quickly in terms of dollars and unnecessary suffering. Given the enormous need for highly coordinated care within the U.S. healthcare system, care coordinators could play both a clinically and fiscally effective role in improving the delivery of medical services while reducing overall costs.
Care Coordinator Duties
The overall mission of care coordinators is to ensure a continuum of patient care by identifying potential barriers to needed medical services and promoting communication to overcome those barriers. Care coordinators perform a variety of duties in order to achieve those goals. These include screening patients regarding their need for care coordination; developing a plan of care with a patient’s primary care physician; facilitating medical appointments and communications between primary care and specialty providers; scheduling interpreter services for patients whose speak a language other than English; and documenting patient encounters.
But where are the trained hands to perform these roles, many of which do not require a clinical license? The demand for nurses to perform clinical work is extraordinarily high, leaving in question whether they are the best point persons for care coordination. These were the issues facing Swedish Health Services, an operator of five hospitals in and around Seattle.
“Everyone should be operating at the height of his or her license,” said Liga Mezaraups, administrative director of care transformation for Swedish Health Services. Swedish does employ nurses as ambulatory care managers who focus on patients near or at discharge from the hospital, or are receiving follow-up care in Swedish clinics. But the need for nurses elsewhere reduced the care manager team from 10 to six in recent months.
Still, Swedish needed to better focus on transitions of care for patient populations at “higher risks at the time of transition” because of issues that may never come up while they are hospitalized.
Care Coordination Scholars
Enter the care coordinator: a non-nurse employee with some clinical experience who can better ensure care is finely coordinated for vulnerable patients but who do not require a nursing or other clinical license in order to do so. Swedish contracted with COPE Health Solutions earlier this year to begin the training of its first cohort of Care Coordination Scholars in its clinic settings. Eleven individuals were chosen for training, all recruited from the Health Scholar program already in place at Swedish, although there are plans to expand recruitment in the near future to emphasize certain language skills needed among the patient population.
The Care Coordination Scholars share common characteristics, including empathy, compassion, organization and even a sense of humor-all of which help them to engage patients. They must also demonstrate a high degree of integrity, given their access to patient medical records. Participants in the Care Coordination Scholar training program closely observe the work nurse care managers perform, along with Swedish’ s nurse practitioners and patient care coordinators.
Most of Swedish’s first Care Coordination Scholar recruits intend to pursue either a medical or healthcare management career themselves and have participated in the Swedish Health Scholar program. All are nearing the end of their undergraduate studies or have just earned a degree. Care coordinators should always work under the guidance of a licensed clinical professional to ensure an immediate resource if a patient has questions or concerns about their treatment a care coordinator cannot answer.
“How do we make contact with this patient and motivate them?” asks Miotke, one of Swedish’s first Care Coordination Scholar trainees, prior to a patient encounter. The 20-year-old Miotke is studying biology at the University of Washington in Seattle and is applying to medical school after her 2016 graduation.
[pullquote]”A lot of work is dealing with patients who for whatever reason don’t want to continue their medical care,” said Miotke, who has discovered that both diabetes and depression are prevalent in the populations she is advocating for, creating a formidable challenge right off the bat. “We have to change that, and figure out what the overall goals are for each patient.”[/pullquote]
But the key to their success is establishing a warm yet professional connection with each patient. Motivational interviewing is the technique used to instill in the patient a desire and drive to change, while still respecting their autonomy. Pros and cons of a patient’s current behavior and hoped-for behaviors are discussed in depth. Care coordinators are trained extensively in this process, which includes specific rules about etiquette, body language and eye contact as well as the need to repeat the information to the patient in a non-confrontational manner until it is heard and processed.
Most patients eligible for the care coordination program have lifelong habits that can be difficult to change. There is specific training for Care Coordination Scholars regarding how to deal with patients who relapse to old behaviors.
“You need to make the patients realize this is what they want, these are steps for them to succeed, and that will be the biggest thing for their care moving forward. You have to really get them to buy into the whole thing,” said Stephen Ong, another Care Coordination Scholar, who recently graduated with a degree in biochemistry, and is applying to medical schools. To Ong, a care coordinator “fills in the gaps regarding the healthcare they are receiving.” In the end, however, the most important role is to be at the patient’s side as an advocate as they deal with a complex and frightening system.