"Improving the Coordination of Care for Medicaid Beneficiaries in Pennsylvania," Health Affairs, March 2011 30(3):426–30.
Poor coordination of care not only leads to waste, duplication, and medical errors, it also hinders providers' ability to deliver high-quality care. Care managers can reduce gaps in care and increase efficiency by improving communication among providers.
To improve care coordination, Keystone Mercy Health Plan, a Pennsylvania-based Medicaid health plan, placed care managers in provider settings affiliated with Mercy Health System. The care managers helped to identify gaps in care and remove barriers to care in primary care offices. In the hospital setting, the care managers worked to reduce unnecessary emergency department visits and improve communication and coordination among inpatient and outpatient providers.
The rate of hospital admissions per 1,000 members per year decreased by 17 percent, while the length of stay declined by 37 percent. Unpublished data show that per-member per-month savings were $37.70 for the population that received improved care coordination.