Very few things are more debilitating or discouraging to seriously ill patients and their families than navigating the complex U.S. health care system. Going from doctor to doctor, seeking out specialized services from surgery to rehabilitative care, patients often feel alone, confused, and frustrated. Commonwealth Fund surveys have found that Americans are more likely than their counterparts in other countries to report problems with poor coordination of care, including medical records that are not available when a patient shows up for an appointment, doctors who order duplicate tests, and a host of other shortcomings.(9)
About one-fourth of Americans report such problems-the percentage rises precipitously with the number of doctors involved in a patient's care.
A systematic approach to coordinating care can make a difference. The Commonwealth Fund is supporting an evaluation of a project that uses advanced practice nurses to follow elderly congestive heart failure patients after hospital discharge. This simple intervention reduces the percentage of patients who are rehospitalized and cuts the total cost of care by over 35 percent.(10)
The Medicare program has selected this promising model as one of eight to be included in a pilot project on improving chronic care.
There are also considerable opportunities to improve the coordination of acute and long-term care. A Fund-supported study is developing new ways to pay nursing homes to reward those that prevent hospitalization through measures such as influenza vaccinations or prompt medical attention to certain common conditions. Today, hospitalization rates among New York nursing homes vary by a factor of four, perhaps in part because homes receive higher compensation when a resident is hospitalized.
Coordinating payments under Medicaid, which covers nursing home care, and Medicare, which covers hospital care, could help bring financial rewards into alignment with desired performance.