Benefits Administration: Care coordinators fill a healthcare void
Dr. Thomas Ebert is executive vice president and chief medical officer at Worcester-based Fallon Health.
Annual physicals and screenings, eye exams, transportation to doctor’s visits, getting help at home, accessing nutritious meals and exercise—are all health care benefits designed to keep you well. They can also seem overwhelming if you are managing a chronic condition such as asthma or diabetes for yourself, for a child or a frail parent.
Keeping track of appointments with doctors and specialists, sifting through and interpreting information, understanding costs, continuous communication to make sure everyone and everything works together effectively—it can become a full-time job and more than one person can handle.
All of this has given rise to a new job in health care – care coordinators. They have become an indispensable resource helping those trying to manage a chronic condition, or care for a frail loved one.
Based on our experience caring for vulnerable populations, Fallon Health recognizes the value of integrated, coordinated care. Over the past decade, we’ve made investments in this kind of care and care coordinators now represent nearly 10 percent of our workforce – up from zero in 2005, and that percentage is climbing.
What do care coordinators do?
The care coordinator’s list of responsibilities is broad, but can be boiled down to one goal: being the champion of your health.
The care coordinator first works with the member to create a plan, which becomes the blueprint for the member’s care. The care coordinator uses the plan to identify and provide the resources necessary for the member to stay healthy.
The care coordinator also acts as a liaison between the member and a network of providers. Working closely with the member, the care coordinator helps identify any changes in the member’s health and recommends action before a small concern becomes a potentially serious health risk.
Recognizing that no detail is too small when dealing with someone’s health, the care coordinator makes sure nothing falls through the cracks—talking to doctors and other clinicians, booking follow-up appointments, coordinating services and answering questions.
The use of care coordinators has been shown to keep people out of the hospital. In one study, Fallon Health found that its members who were discharged from a local hospital to a skilled nursing facility reduced their average length of stay from 15 days to 8 days with the support of a Fallon care coordination program. Also, after learning that 60 percent of members enrolled in Fallon’s Medicare Advantage plan were being readmitted to the hospital because of medication issues, we now send a pharmacist to members’ homes to coordinate medication management.
The care coordinator’s job does not stop at clinical care.
A study conducted by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute determined that 80 percent of health outcomes are related to behavioral, emotional, financial, educational and other non-clinical issues.
Care coordinators attend to individuals in an array of circumstances—from an 8-year-old boy struggling with asthma to an 88-year-old woman coping with a complicated medication regimen to a 48-year-old man needing help to quit smoking.
Care coordinators wear different hats at Fallon — Navigators, nurse case managers, coaches, disease case managers to name a few – but they all have one thing in common: They provide personal care tailored to the member.
Dr. Thomas Ebert is executive vice president and chief medical officer at Worcester-based Fallon Health.
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