Blue Review
A newsletter for Medicaid providers

July 2019

Coordinating Care Between Providers and Care Settings

The primary care provider (PCP) is the lead of the multidisciplinary team of care providers who are serving our members. Members may not fully understand the critical role the PCP plays in the coordination of their health care. Coordination is needed between primary care and other providers to ensure an integrated plan that avoids duplication, unintentional medication interactions or gaps in care, and potentially preventable emergency department (ED) visits and hospital admissions.

The Agency for Healthcare Research and Quality (AHRQ) has identified four specific points of coordination needed in the medical neighborhood to ensure care is not fragmented and patients are well-supported by their care team1:

  1. Specialists need to let PCPs know what type of routine care a patient needs after surgery or a course of treatment.
  2. PCPs need to make appropriate referrals and provide specialists with the patient’s appropriate background information, clinical data and goals for the consultation.
  3. Hospitals need to let primary care teams know when their patients are in the hospital or have visited the hospital’s ED.
  4. In general, PCP’s and other team members need a broad understanding of each patient’s health care needs to assist in coordinating all care, helping the patient navigate the system, and ensuring that the treatment plans (and prescription medications) of different specialists work together.

Provider Satisfaction Survey Results
Blue Cross and Blue Shield of Texas (BCBSTX) performed a provider satisfaction survey in 2018 that demonstrated when a PCP received information from the ED following a patient visit, the information was helpful in developing a coordinated plan of care. Also, 91% of respondents indicated they had a process for scheduling a follow-up visit. However, only 59% of respondents reported that they usually or always receive a report. In the same survey, 60% of PCP respondents said they usually or always receive follow-up information from a behavioral health referral. This shows improvement over prior years, but there is still opportunity to ensure better integration and coordination of care across care settings.

Best Practice Summary
What providers can do to improve coordination of care:

  1. When PCPs make a referral to a specialist, develop referral patterns with the expectation that follow-up communication is obtained after the specialist visit.
  2. Behavioral health and other specialist providers should develop office procedures to ensure reports or communications are shared – with appropriate patient consent – with the PCP after a patient visits the ED. ED physicians should contact the PCP, when possible, to obtain the patient’s known baseline.
  3. Hospitals and emergency providers need to develop standard processes, so the PCP is informed of a patient visit. When the patient does not know who their PCP is, contact BCBSTX Customer Service at 1-888-657-6061.
  4. PCP offices should schedule patients for a follow-up visit to occur within at least 7 days of an emergency visit or hospital discharge. This will help stabilize care and educate the patient on appropriate access to care if the emergency visit was not an emergency.

Resources

Refer members who need assistance coordinating care or locating providers to our BCBSTX Case Management/Disease Management/Service Coordination team at:

  • STAR/CHIP Members: 1-877-214-5630
  • STAR Kids Members: 1-877-301-4394

Reference:
1 Agency for Healthcare Research and Quality. (2011, June). Coordinating care in the medical neighborhood: critical components and available mechanismsAdobe Acrobat Icon.