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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.
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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