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Learn The Lingo

Learn the Lingo: Key Terms for Navigating the Value Based Care World

With the shift toward value-based payment models, pharmacists are seizing new opportunities to improve patient care in medical homes, accountable care organizations, and other innovative care models. This resource includes acronyms and terminology commonly used when practicing in or discussing innovative practice models. Each term includes a short description and references so you can further your practice in a value based care world. This is the first of multiple volumes that will be published by the Medical Home/ACO SIG.

Published on Friday, March 11, 2022

Case Management/Care Coordination

Definition: Case management is defined as the assessment, planning, and care coordination of services to meet a patient’s individual health care needs. Case managers often advocate for patients’ safety and positive health outcomes through appropriate care coordination and communication.1 Meanwhile, care coordination refers to the organization and planning of patient care activities and sharing of information between two or more participants who are involved with the patient’s care in order to achieve better health outcomes and provide safer care.2 Both of these terms go hand in hand to ensure patients’ unique health care needs are met and to achieve better health outcomes. If a patient's care is well-coordinated, this can avoid ER visits and hospital readmissions, decrease medical errors, and decrease health care costs.3

How it relates to ACO/PCMH: ACOs and PCMHs encourage providers to focus on the quality of patient care. Case management and care coordination emphasize that improving the quality of a patient’s care is a team effort and that the proper coordination of care across a continuum of services is crucial to such quality of care. Elements that are vital to the PCMH such as continuity of care and expanded access to care are accomplished through appropriate care coordination. The health care team (consisting of a case manager, pharmacist, social worker, physician, nurse, etc.) should all work together to create a proactive care plan for the patient as well as establish appropriate monitoring and follow-up for smooth transitions of care.2 Care coordination also consists of providing patients with community resources and taking into account the patient’s individual goals. These processes strive to combat the disjointed nature of current health care systems and standardize the care that a patient may be receiving from multiple settings, especially when it comes to chronic conditions.2

Involved organizations/oversight: The Agency for Healthcare Research and Quality (AHRQ), Institute of Medicine (IOM), and National Quality Forum (NQF) encourage current health care systems to implement and measure properly coordinated care.2,3,4 NQF and AHRQ have developed guidelines and measurement tools to help assist with this implementation.5,6 These guidelines emphasize increased communication between different health care providers and specialists, more information sharing between all parties, a higher focus on person- and family-centered care, and better affordability of quality care.6 Developing and implementing care coordination and case management strategies can help save money for any institution and improve the overall health outcomes of patients.

Resources:

1. Case Management Society of America. What is a case manager? CMSA: Case Management Society of America. https://www.cmsa.org/who-we-are/what-is-a-case-manager/

2. Agency for Healthcare Research and Quality. Care Coordination. AHRQ: Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/care/coordination.html

3. National Quality Forum. Care Coordination Measures. National Quality Forum. https://www.qualityforum.org/ProjectDescription.aspx?projectID=73700

4. Frieden J. IOM: Prevent bad diagnoses with better care coordination. MedPage Today. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/53686

5. Agency for Healthcare Research and Quality. Care Coordination Quality Measure for Primary Care (CCQM-PC). AHRQ: Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/care/coordination/quality/index.html

6. National Quality Forum. National voluntary consensus standards for coordination of care across episodes of care and care transitions. National Quality Forum. https://www.qualityforum.org/Projects/c-d/Care_Coordination_Endorsement_Maintenance/Care_Coordination_Endorsement_Maintenance.aspx

Contributing Author:

Hindu Rao, PharmD

Clinical Assistant Professor of Pharmacy Practice

Chapman University School of Pharmacy

 

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Author: Annette Jones

Categories: Learn the Lingo

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