4 Steps to Addressing the Failure Points in Care Coordination

pCare Team

March 26, 2021

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Care Coordination is complex, and the failure points can seem infinite.  Numerous studies have outlined the inherent issues of our fragmented healthcare system, the root causes and resulting mish-mash of trying to coordinate with providers across points of care.  On top of all that is the huge cost impacts of poor care coordination.  Solving the care coordination conundrum is indeed a daunting undertaking.   During a recent PX Marketplace Webinar sponsored by The Beryl Institute, Dave Bennett, CEO of pCare and Carina Edwards, CEO of Quil, outlined a 4-step action plan for addressing the failure points.  They also shared what redefining patient engagement for today’s consumer looks like.

The goal of the first step is to identify where you first want to start taking action.  Ultimately you are answering the question of what failure point to address first.  To arrive at this decision, be sure to have a clear understanding of the overarching objectives for improved care coordination.  Is the focus cost reduction? Improved experience for patients?  Staff efficiency or ways to alleviate care team burnout?   As you catalog the various care coordination failure points, analyze available data to identify one that will have a meaningful impact on that primary goal but that is not too big to tackle as you get your feet wet.  For example, if duplicative tests is a driver of unnecessary costs, perhaps you home in on one specific set of frequently ordered labs as your pilot project.

When a failure point has been identified, it’s time to get to work by aligning key stakeholders – leadership and decision influencers that will drive the initiative forward – around your SMART goals for success.   As healthcare is a discipline rooted in science, during this phase it’s critical to leverage data and use your measurement benchmarks as a common language amongst what can be a diverse group of stakeholders, especially if your initiative is engaging some mix of providers, administrative staff, and even patients.  Try a fishbone exercise to get a common framework around root cause analysis.

With a failure point identified and a SMART plan in place, during the third step you will establish a clear understanding among all the parties engaged of the diversity of perspectives that care coordination needs to accommodate.  Teams create the foundation for reducing friction that can then be operationalized much more broadly when this is done right.   The trick is to foster that appreciation within the context, or under the umbrella, of consumer-centric care.   Consider the duplicative test avoidance example. A provider in our system is paid for ordering tests.  Initiatives that reduce test volume may not be readily embraced.  However, appealing to time constraints on physicians and the potential to avoid waiting for a duplicative test could be compelling.  You are empowering the physician to get to an answer sooner while delivering a better care experience for the patient.  And the patient is saved the hassle of getting that duplicative test.  The script has been flipped by appealing to a factor important to the provider (speed to diagnosis) within the context of delivering a better experience (patient-centricity).

The final step is to apply all that has been gathered up to this point toward innovative solutioning.  Within the context of SMART, it’s important to enhance existing workflows.  Don’t reinvent the wheel or ignore the benefits inherent in any tools in use.  The approach needs to be data driven and must take into account the various needs of stakeholders.  The caution is NOT to automate current bad processes but to leverage technology’s inherent advantages to achieve the desired outcome.  In our example, we know that if we use a remote data entry app to collect test history from the patient, the effort will fail. Patients do not know their test history.  Asking online doesn’t help.  However, querying the payer’s claims system should not only identify if that test was taken but where so results can be pulled.  Building the interoperability to create that coordination is an example of innovation solutions required to use technology to address the failure points in care coordination.

As the saying goes, the way to eat an elephant is one bite at a time.  With clear objectives in mind, moving deliberately through failure points in care coordination across the continuum can be addressed.  To succinctly sum up:

  1. Identify the main points of failure
  2. Set your SMART goals
  3. Know Your Demographics
  4. Solution and Innovate

Follow the four steps, and over time the results should be better outcomes and experience for patients and families, more efficiency and job satisfaction for providers, and lower costs for payers.  And don’t forgot, although the work is challenging, do enjoy the journey.

About pCare

pCare’s cross continuum, patient engagement solutions help healthcare providers educate and collaborate with patients. The pCare open platform integrates with existing EHR/EMR systems, patient portals, and digital health applications to connect patients, families and caregivers. Recognized by KLAS as the quality leader in the interactive patient systems category, pCare is the partner leading healthcare organizations trust to improve care quality, patient outcomes, and financial performance. To learn more, visit