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Structuring, Financing and Paying for Effective Chronic Care Coordination

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Document date: July 01, 2009
Released online: September 11, 2009

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Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

Executive Summary

In the current health care reform debate, enhanced care coordination for people with serious chronic conditions is receiving attention as a key approach for improving both clinical quality and the experiences of patients and family caregivers, while helping to reduce health care spending. This paper explores options for structuring, financing and paying for care coordination that span the medical care and social support dimensions. It draws from research and demonstrations on the traditional fee-for-service Medicare population that focus on the medical dimension and also from research and demonstrations from Medicaid, Medicare Advantage, and programs of the Administration on Aging that have studied long-term services and supports not covered by traditional Medicare.

This final document, first prepared as a Working Paper that provided the basis for an invitational meeting on June 3, 2009 convened by the National Coalition on Care Coordination (N3C), incorporates observations and suggestions offered by three discussants and more than forty participants at the meeting.

This paper takes a broad view of care coordination, as characterized by the N3C definition: “Care coordination is a person-centered, assessment-based interdisciplinary approach to integrating health care and social support services in which a care coordinator manages and monitors an individual’s needs, goals, and preferences based on a comprehensive plan.” The paper (1) considers the various populations in need of care coordination; (2) summarizes current evidence regarding the components of effective care coordination; (3) describes the various entities that are serving as the organizational focal point for plausible models and interventions, briefly presenting innovative examples of each type; (4) explores financing and payment options that can support these organizational approaches; and (5) presents conclusions and policy implications.

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Topics/Tags: | Health/Healthcare

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