Spider Webs of Care Coordination Networks

We have learned that coordinating care of patients — particular care of Medicare patients — is complex and time consuming for physicians.

A breakthrough study quantifies just how complex and challenging care coordination really is.  The study is reported in the February 17 issue of Annals of Internal Medicine and is entitled Primary Care Physicians’ Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination :

We found that in a single year for just fee-for-service Medicare patients, the typical primary care physician needs to coordinate care with 229 other physicians working in 117 different practices…. The number of peers was greater for physicians treating patients with higher chronic illness burden, who may benefit the most from coordination.

My mental visualization of these networks is a series of spider webs.

The authors write that “Coordination involves complex activities that require conscious interactions between providers and between providers and patients, including timely transfer of accurate clinical information, effective communication between the involved parties, and shared decision making.”

The estimate of 229 physicians in 117 different practices is conservative:

• We did not consider nonphysician providers, such as nurse practitioners, or peers exclusively involved in the care of the primary care physician’s non-Medicare or Medicare managed care patients.
• We assessed the number of peers but not the efforts related to other important coordination activities, such as the frequency, mode, or quality of communication with patients’ families or of interactions between providers.
• Neither did we examine other obstacles to coordination in a program of national scope.

The authors note that their study has implications for initiatives such as the patient centered medical home (PCMH) and physician payment reform:  “…such strategies may not succeed if they do not realistically assess the magnitude of care coordination tasks within the current system.”