Highlights
- •Value-based payment is leading to enhanced care coordination staffing.
- •Sites are task shifting low-complexity care coordination to unlicensed staff.
- •Important care coordination education gaps necessitate in-depth on-the-job training.
- •Demonstrating the return on investment of care coordination staffing remains a challenge.
Abstract
Background
Care coordination is generally viewed as a key to success for health systems seeking
to adapt to a range of new value-based payment policies.
Purpose
This study explores care coordination staffing in four health systems participating
in new payment models, including Medicaid payment reform and Accountable Care Organizations.
Methods
Comparative case study design is used to describe models of care coordination. Analysis
of 43 semi-structured interviews with leadership, clinicians, and care coordination
staff at four health systems engaged in value-based contracts.
Discussion
Each of the sites engaged in significant task shifting of low-complexity care coordination
activities to licensed practical nurses, medical assistants, and other unlicensed
personnel freeing up registered nurses and social workers for more complex patients.
Few have care coordination experience, requiring a significant investment in on-the-job
training.
Conclusion
Payment reform is leading to a greater investment in the care coordination workforce.
However, demonstrating the return on investment remains a challenge.
Keywords
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Article info
Publication history
Published online: April 13, 2017
Accepted:
April 6,
2017
Received in revised form:
April 3,
2017
Received:
January 26,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
