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Health & Well-Being » Coordinated Accessible Healthcare

Why It's Important

Coordinated accessible health care is a theory of coordinating care and sharing information among the various parties that are involved in healthcare provision, including the patient, providers and facilities (such as hospitals and labs). Accessible means patients are afforded the most appropriate healthcare resources in their community in a timely manner. It has been an effort to contain costs via efficiency. It was thought that in a fee-for-service environment, coordinated care would reduce rates of unmet service needs, ED use, acute care use, hospitalizations and total health care costs -- all while improving patient and caregiver quality of life. However, this hasn’t always been the case, for various reasons.

 

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How Richmond Is Doing

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How Virginia Is Doing

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How the U.S. Is Doing

According to “The Medical Home: A Vehicle for Providing Patient-Centered, Accessible, Coordinated, Effective and Efficient Care,” patient-centered medical homes are associated with better outcomes, lower costs and greater patient satisfaction. In a seven-country study, most adults report having a regular source of care, but only about half have a physician practice they perceive as knowing them and being accessible and helpful in coordinating care. New models of patient-centered care in the U.S. are promising; most involve changing financial incentives. This study found that in each of seven countries (Australia, Canada, Germany, The Netherlands, New Zealand, the UK and the US), having a “Medical Home” improves patient experiences.

(COMMONWEALTH FUND, THE MEDICAL HOME, 2008)

In a recent article published in the Annals of Internal Medicine on coordinating care, primary care physicians are responsible for coordinating care that their patients receive from other physicians. This role will probably expand with the implementation of such models of care as the patient-centered medical home. Investigators analyzed survey data from 2,284 primary care physicians and claims for the Medicare beneficiaries they cared for in 2005. They estimate that, for every 100 Medicare patients a physician treats, the physician potentially must interact with 99 other physicians in 53 different practices. To coordinate care of patients for whom they are the primary care physician, physicians must coordinate with a large number of other physicians.

  • Primary care physicians caring for their own primary and non-primary Medicare patients during a single year potentially must coordinate with many other physicians, according to the results of a cross-sectional analysis of claims data reported in the February 17 issue of the Annals of Internal Medicine.
  • The goal of this study was to determine the number of physician peers providing care to the Medicare patients of a primary care physician, using a sample of 2,284 primary care physicians who responded to the 2004 to 2005 Community Tracking Study Physician Survey.
  • For each primary care physician, there were about 229 other physicians (interquartile range, 125-340 physicians) working in 117 practices (interquartile range, 66-175 practices) requiring coordination of care. For every 100 Medicare beneficiaries managed by the primary care physician, this would translate to an additional 99 physicians and 53 practices.

(ANNALS OF INTERNAL MEDICINE, 2009)

Data & Information Sources

Annals of Internal Medicine, Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination, 2009

http://www.annals.org/cgi/content/abstract/150/4/236

California Association of Physician Group, From the Point of Care, 2007
http://capg.org/docs/from_the_point_of_care.pdf

Federal Interagency Forum on Aging Related Statistics
http://www.agingstats.gov/agingstatsdotnet/main_site/default.aspx

The Commonwealth Fund, The Medical Home: A Vehicle for Providing Patient-Centered, Accessible, Coordinated, Effective and Efficient Care, 2008
http://www.pickerinstitute.org/awards/Davis%20PPT.ppt

U.S. Census Bureau, American Community Survey
http://www.census.gov/acs/www/

VNSNY Center for Home Care Policy & Research, CHAMP-Advancing Home Health Care Excellence for Older People, Care Coordination, Management & Transistions, 2009
http://www.champ-program.org/framework/documents/CHAMP-Care_Coordination_Management_and_Transitions.pdf