The number of Americans with at least one chronic health condition is rising. These patients have higher than average healthcare utilization rates, making the management of their care particularly vital, yet complicated. The successful management of patients with care conditions requires care that is well-coordinated between providers, patients, and the care team. 

Care coordination is any activity that helps ensure that the patient’s needs and preferences for health services are met over time. This includes how information is shared across people, functions, and sites throughout their patient journey. Care coordination promotes cooperation and information-sharing between multiple providers and specialists serving a patient, reducing fragmentation throughout care.

Coordinating chronic care for patients after they leave the hospital (or clinic) is one of the most time-consuming tasks for providers. It is also one of the most crucial. 

Not only must hospitals ensure that their patients are prepared for discharge, but they must also reach out to patients multiple times after to ensure they are staying on the path to recovery. This communication helps ensure patients have their medications, schedule their follow-up appointments, and understand any other critical pieces of information. Improving the coordination of care post-discharge from healthcare facilities can reduce avoidable readmissions, decrease emergency department visits, improve compliance, and keep patients healthy.

Understanding the benefits of care coordination

Employing a care coordination team, or empowering providers with the technology to more efficiently coordinate effective care management after discharge improves the overall quality of that care.

Care coordination enables providers to:

• Work at the top of their credentials. Physicians have more quality time to care for patients, since patient care coordinators can directly handle or facilitate with the physician’s care team for a wide range of patient care tasks. 
• Improve utilization management. Care coordination allows physicians and other care team members to focus on proactive care, rather than react to expensive, acute care episodes. Providers that coordinate care for patients can identify their needs before appointments, allowing them to make the most of limited face-to-face or virtual time.
• Engage patients in their own care. As extensions of the physician, patient care coordinators can stay intricately connected to patients. Regular communications help engage patients and focus their attention on preventative actions. Care coordinators gain in-depth insight into a patient’s social determinants of health (SDoH) and can help address potential barriers interfering with their appointments, medications, or other care plan steps.
• Enter value-based contracts with greater confidence. Most value-based models require providers to demonstrate ongoing quality improvement, patient satisfaction, and lower overall cost of care — all achievable goals with a strong care coordination structure.
• Improve patient engagement and experience. Chronically ill patients often report poor medical experiences. They are often overwhelmed and overrun by the many moving parts of their care. Care coordination is helping to increase patient engagement and improve their experience. Patients are happier and feel healthier when taking an active role in their care plan. They no longer feel like they must take it all on by themselves. Instead, they have someone in their corner helping them keep everything organized and engaged.

Care coordination benefits patients, providers, and payer organizations. Patients receive optimal care, providers are better informed, and there is less wasteful spending on things like unnecessary testing or duplicative procedures. 

More than that, connecting each member of a patient’s team and giving patients the resources they need to seek help, keeps patients out of the hospital. 

Coordinated care solutions with Salesforce

As the healthcare industry transitions to a value-based system, communication with patients before and after their encounters with a health system will become paramount. 

Salesforce Health Cloud puts the patient at the center of the care and enables the healthcare provider to gain a complete view of the patient with integrated data from EHRs, wearables, and more. Moreover, it allows them to make a smart care decision from a single console to deliver:

• Complete 360-degree view of patient data (by combining patient data from EHR and other third-party sources) for easy access to the right patient information, from current conditions and medications to specialists and appointment history.
• Deeper patient engagement, with the ability to prioritize tasks across all a patient’s needs, connect with caregiver networks, and create a customized care plan.
• Improved patient management through private Salesforce Communities, allowing caregiver networks and patients to share secure messages anytime, and anywhere for a more personalized healthcare experience.
• Empowered healthcare team members who can choose the best health care plans, view the associated teams, and track their task assignments.
• Secure collaboration between care coordinators across the full health care system. Work with patients to track progress against care plans or health goals; easily communicate with primary care practices, physicians, care coordinators, and family members; and get answers quickly from specialists across the provider network.

A trusted implementation partner

With deep industry expertise and specialization in legacy and cutting-edge technologies, Silverline is poised to help your and your team adopt and adapt to new methods of managing care coordination programs. 

We’ll help you build an exceptional experience to better serve your patients and improve patient-provider engagement. For more information about our care coordination solutions, look no further.