By Valerie Hawkins, OSF St. Joseph Medical Center
When purchasing a home, many people choose to hire a realtor. The realtor listens to the home buyer’s needs and wants, researches available homes within their means, and then coordinates all of the messy paperwork and appointments. There are many people involved with buying a home — sellers, lawyers, and loan officers. Therefore, coordinating such a large task with a large amount of people can be difficult.
Think of buying a home the same as coordinating your health care. You see various specialists to meet your different needs and wants, you research different providers to see which is in-network, and you coordinate dozens of appointments. There are many people involved — physicians, social workers, and family members. So, why not seek out a “realtor” to help coordinate your health care needs?
Health care organizations nationwide recognize this need for better-coordinated care for patients. One answer to this ever-growing dilemma is accountable care organizations.
Accountable Care Organizations
Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health care providers working together to provide coordinated care to their patients. This results in better service, better quality, and better care at a lower cost for patients.
The goal of coordinated care is to ensure patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services. This involves innovative approaches to care coordination and special attention to those with multiple complex medical problems.
Individuals who provide this specialized attention and care coordination are called patient care managers.
Patient Care Managers
A patient care manager is exactly what it sounds like — a health care professional, typically a nurse or social worker, who coordinates a patient’s care by arranging, monitoring, and organizing services throughout a patient’s lifetime.
Think of a patient care manager as your health care realtor. High-risk patients are matched with a care manager, who works closely with them and their loved ones to develop a customized health care plan to address their specific health care needs.
The patient care managers closely monitor patients during office appointments, with phone calls and home visits, and they serve as a liaison between the patient and the many other members of the care team — including their primary care physician, social worker, pharmacist, and community resources specialist.
Patient care managers also help to coordinate services such as diagnostic tests, social services, and specialist services. So whether it’s helping to arrange transportation, finding a home care nurse, or locating the appropriate mental health services, the patient care manager is there, every step of the way, for these high-risk patients.
Somebody Who Cares
Most patients know how to take care of themselves, but are overwhelmed and aren’t sure where to start. Patient care managers can help the patient set small, attainable goals, and work toward larger ones. Patient care managers also help address emotional needs as well as clinical needs. A patient care manager offers moral support in a genuinely caring manner, to make each patient feel loved and valuable.
For example, a patient might suffer from a variety of chronic conditions, including obesity, diabetes, hypertension, and asthma. They may also be suffering from a physical or mental disability. It’s quite common for patients in these situations to ignore recommendations to follow the proper diet, get exercise, and take their medications.
Most patients know what they should do to take care of themselves, but they just aren’t motivated to do so. A patient care manager talks with these individuals, and helps meet their emotional needs just as much as their clinical needs.
By helping patients feel worthy, valued, and empowered, they become more willing to take part in their own care.
Take Action
There is no cost for patients to participate in an ACO, and a patient’s health benefits do not change. Patients may still see any doctors or health care providers they choose, even if those providers are not part of an ACO.
Patients cannot opt out of the ACO program. However, patients may choose not to share their health information with the ACO. Sharing health information will allow the ACO to better understand each patient’s health history and identify information or services that may be of benefit to him or her. This information will be shared with the patient’s primary care doctor so it can be discussed as needed.
You may think health care is only the responsibility of doctors, nurses, and hospitals, but the new model for health care defined by ACOs impacts everyone including patients and families. With the medical landscape changing at a rapid pace, it is important for all parties involved, including patients and families, to be aware of the roles and responsibilities they have. If you believe you or a loved one may benefit from coordinated care, talk to your primary care physician about ACOs in your area.
In 2013, OSF Healthcare System hospitals, physicians, advanced care practitioners, home care services, and pharmacies in Central Illinois were selected to participate as a Pioneer Accountable Care Organization (ACO) with the Center for Medicare and Medicaid
Services (CMS).
For more information, patient stories, and an ACO provider list, please visit www.osfhealthcare.org/aco.
Photo credit: Dean Mitchell/iStock