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Journal Article


Care Coordination Agreements: Barriers, Facilitators, and Lessons Learned



The Issue

Primary care practitioners are being asked to coordinate the care of their patients, especially those with chronic illnesses who visit multiple providers. One tool that can help is the care coordination agreement (CCA)—a written contract that defines the level of care expected from each provider and sets out specific tasks for which each will be responsible. Despite early evidence that these agreements can result in decreased cost and higher quality of care, little research has been done on how best to design CCAs and what factors lead to more successful provider partnerships.  

What the Study Found

Based on 37 telephone interviews conducted from July 2010 to April 2011 with care coordination experts and health care providers, Commonwealth Fund–supported researchers learned that CCAs increased efficiency and improved the quality of care, especially for patients with chronic conditions. These care agreements were most successful when they were based on mutual trust between providers. Compatible health information technology systems and dedicated staff to oversee the progress of the CCA helped to ensure the long-term sustainability of such agreements.



Care coordination agreements hold promise to improve the care of patients treated by multiple providers, and their use is likely to grow. But low-cost policy changes are needed to encourage more providers to develop agreements and undertake formal study of their effects. These include policies that promote a move from fee-for-service reimbursement to collaborative models of care. In addition, further research is necessary to determine whether certain types of CCAs are more effective than others in improving the quality, efficiency, and patient-centeredness of care.

Publication Details



E. Carrier, M. K. Dowling, and H. H. Pham, "Care Coordination Agreements: Barriers, Facilitators, and Lessons Learned," The American Journal of Managed Care, Nov. 2012 18(11):e398–e404.