Patient Care Coordination Supports Patient-Centered Care
When a patient is diagnosed with a chronic or emergent physical health condition, substance use disorder (SUD), or another mental health condition, they may struggle with when, where, and how to seek care. In particular, those diagnosed with two conditions at once often have unique needs that are difficult to meet and costly to manage. So, what is a patient, or their employer, to do?
The healthcare system in our nation is incredibly complex, and it’s often difficult for patients and their family members to traverse on their own. However, it’s a system that can be navigated effectively, especially with the help of a professional. In the above scenarios, patient-centered care is critical, and it begins with access to patient navigation services.
Such providers work with individuals and their families to ensure patients receive the treatment they need. Finding the right treatment providers and plans can be challenging, especially considering the complexities of the healthcare system.
Understanding Patient Navigation
Patient care coordination is crucial for staying physically and mentally healthy. So, what is patient navigation?
Patient navigation services are intended to help the patient in question receive the care they need as soon as possible. Patient navigation also involves helping consumers understand their health plan options. Patient navigators are responsible for assessing each patient’s immediate needs and developing a framework to ensure effective care in the future.
As part of this task, navigators may prepare applications or help a patient enroll in the marketplace to qualify for an insurance program. Patient navigators may also work with patients to understand the medical system, overcome any barriers that might arise, and select a care option that meets their needs.
Patient navigators typically help individuals with serious conditions like cancer but can be utilized for patients with any illness or mental disorder. Because these patients are likely to see several doctors and must undergo many procedures, a patient navigator communicates with their healthcare providers so they can make the best decision regarding their healthcare.
Payer vs. Provider Patient Navigation
To truly understand the concept of patient navigation, it’s important to note the difference between provider and payer navigation. Providers and payers are not always the same, as providers are the ones who offer healthcare services, including hospitals and clinics. Payers are the organizations who collect payments and set service rates. Payer companies include Medicaid and Medicare.
Patient navigators work within the payer space, according to the Centers for Medicare & Medicaid Services (CMS). Navigators are required to complete federal training, a criminal background check, and state training and registration. In many states, navigators do not have specific education requirements.
Why Is Patient Care Coordination Important?
Care coordination is defined as a function that ensures the patient’s needs and preferences are met by the healthcare system over time. Without coordination, several potential issues could arise—some as severe as death. If communication is lacking between providers and patients, such as unawareness of medications the patient is already taking, this could lead to poor outcomes and even death.
Lack of care coordination is also costly for both patients and healthcare providers. Poor communication and roadblocks to proper care can increase the risk of hospitalizations and lead to unnecessary or more intensive procedures. Care coordination is a critical part of a patient-centered care (PCC) plan that allows healthcare professionals to address any concerns the patient, employer, or family members have.
In some cases, individuals may feel they don’t have the ability or means to seek healthcare. In others, unfair policies and inaccessible treatments can cause a roadblock to proper care. Through patient-care coordination, navigators fight for health equity, which means everyone has an equal opportunity to access quality medical care.
How Care Coordination Affects Patient-Care Outcomes
By creating a coordination plan, businesses and managers can enable patient navigation professionals to navigate the complicated healthcare system and assist employees.
While PCC is defined differently in various settings, there are a few common elements that make PCC work:
- The healthcare system’s mission and the business’s employee care goals are aligned with the patient’s needs.
- Care is accessible and collaborative, meaning care can be provided anytime, anywhere.
- The patient’s preferences and values are respected.
- The patient’s family plays a vital role in decision-making, and their presence is encouraged.
- All information is shared in a timely manner, so everyone can make informed decisions.
PCC is important due to how much it benefits everyone involved.
Both business owners and patients can experience the following through PCC:
- Improved satisfaction scores.
- Reduced expenses throughout the treatment plan.
- Enhanced reputation of providers.
- Improved resource allocation.
- Reduced absenteeism.
It’s important to note that PCC differs from standard care primarily regarding how patient issues are viewed and handled. For example, if a patient visits their doctor and discusses a problem they’re having, the focus is on treating the problem, not on any diagnosis. Care coordination plans allow strong doctor-patient relationships to form, making treatment and communication easier for both parties.
Another notable benefit of PCC is the fact that patient navigation can be contracted out to a professional like those here at Apogee. As a result, a business is not forced to hire a full-time employee to create a coordination plan. Instead, one can focus funds and energy elsewhere while a contractor creates patient plans that benefit both the organization and the patient involved.
Why Does Care Coordination Matter?
There are significant benefits experienced from PCC and care coordination programs. Here are a few of the most significant.
Don’t Need to Rely on Inexperienced HR Staff
Often, a company’s human resources (HR) director is tasked with finding the right treatment to address patient needs. When patient needs involve behavioral health treatment, this happens even more frequently. However, HR staff are often not experienced, let alone professionally trained, to assist employees with physical and mental health issues. All too often, this means the employees in question don’t receive the care they need.
By creating a care coordination plan, employees who are struggling with physical and mental health issues can navigate roadblocks to effective treatment and access the proper care. This enables an HR department to tend to other pressing matters.
Care Coordination Can Increase Productivity
By having a trained professional available and ready to help, employees can experience a decrease in depression and anxiety on the job. Patients can also address physical health needs more quickly, reducing absenteeism and increasing productivity. In addition, an existing HR staff can return to their designated roles.
Care Coordination Increases Employee Retention
Many employees leave their jobs due to mental health issues. Others leave undesirable employee health plans in search of patient-centered care. In addition, according to the National Alliance on Mental Illness, people with mental illnesses have a 40% higher risk of developing cardiovascular disease. Patient navigators can help reduce the number of deaths by assisting those with mental illnesses. By addressing employee health concerns efficiently, one’s less likely to lose employees after they experience an adverse health event.
Care Coordination Can Increase Employee Satisfaction
A great healthcare plan is an essential component of many job searches. It’s also a key reason many employees choose to stay, as mentioned above. Employees who know they have access to the help they need should they encounter a serious medical or mental health issue are often more satisfied with their positions, further reducing the risk they will leave or become apathetic and unproductive in the workplace.
The Future of Care Coordination
Care coordination has reshaped the way health systems are managed and designed. Providers and employers alike are beginning to view navigators as “team members,” as they’re directly involved with meeting the patient’s needs to benefit all involved. While PCC and care coordination have greatly improved, there are still ways to improve the future of care coordination.
Research has demonstrated the potential benefits of PCC, but there is still room for improvement. One aspect researchers have begun to investigate more thoroughly is how PCC can help meet the emotional needs of patients. One study claimed that half the patients involved did not receive sufficient levels of emotional support from their providers. As a result, emotional support to further improve PCC is one area providers and patient navigators alike should consider when offering their services.
Discussing the costs of PCC can also improve its future. Discussing the cost of healthcare is difficult for both parties, as every patient reacts to this topic differently. However, if PCC becomes the future of primary medicine, healthcare organizations need to be prepared to have these difficult conversations. Remaining open and transparent about the services offered by PCC and the cost involved for all parties is a critical step to improving care.
Employers Can Nurture a Patient Navigation Services
The healthcare industry continues to evolve and focus on PCC, and with that comes the need for effective patient navigator programs. When considering adding patient navigation to an organization’s offerings, it is essential to begin by considering the needs of employees. Together, the boss and the navigator can design a clinical navigator program that will address those needs.
Creating a patient navigation program involves two key steps: designing the program and planning to support the program.
Design the Program
An organization must first determine which type of staff to employ and how they will work with community partners to facilitate the program. For some, staff may consist of nurses, social workers, or community health workers; in most cases, a professional patient navigator is all that is needed.
Determine the general structure of the program, then decide how the navigator will communicate with the patient. Options may include phone, email, or in-person. Navigators also need to understand if they will be working within the health system or independently to help patients arrive at the best care for their needs—often, reviewing the patient’s clinical data can help all involved arrive at the best decision.
Above all, facilitating strong relationships between patients and patient navigators, patients and physicians, and employers and employees is the most critical component of an effective program. When looking for patient navigators for a program, consider only those who have exceptional communication and interpersonal skills.
Support the Program
After designing the navigation program, one must assess an organization’s resources, including the personnel managing the program and the physical tools the navigator will use.
The resources used to support the program should achieve the following:
- Enable patients to receive high-quality support.
- Enable the organizers to hire or contract, train, and supervise the patient navigator.
- Provide technology to the patient navigators.
To reduce the costs of the patient navigation program, organizations can share costs with other programs in the organization or contract patient navigators. Organizations can also consider grants from the federal government, state health departments, medical societies, and more.
Behavioral Healthcare Patient Navigation Services at Apogee System Consultants
The healthcare space is massive, which can cause confusion for the patients and employers who must traverse roadblocks in two entirely different areas. Most struggle to find adequate support on their own, so a patient navigator is an essential component of finding wellness. PCC continues to change the healthcare industry, and the results are quite positive.
Apogee System Consultants can help in providing healthcare patient navigation services. Contact us if you are interested in learning more!