Here at DiabetesSelfManagement.com, we often use the phrase “health-care team,” meaning all the doctors, nurses, and other health-care professionals who manage the various aspects of a patient’s health. This phrase evokes the image of a group that communicates and coordinates with one another, putting their minds together to provide better care than each of them could individually. It’s a happy picture, representing how health-care systems ideally operate. It’s also, more often than not, a far cry from reality.
The fact that typically nobody is coordinating care is health care’s “dirty little secret,” according to an article published last year by Kaiser Health News. That article discussed some of the frightening results of the lack of coordination in hospitals, but it could just as easily have referred to care outside of hospitals. According to the results of a survey published earlier this month by the John A. Hartford Foundation, only 27% of older Medicare-eligible patients said they received coordinated care when given various descriptions to choose from. Within this group, 83% said that getting this type of care had led to improvements in their health. Among survey respondents who didn’t indicate receiving coordinated care, 73% said they would like to receive care under this model.
So what are the barriers to coordination among health-care providers? According to a study published yesterday by the journal JAMA Internal Medicine, coordinated care is difficult because patients want, and choose, to see doctors — especially specialists — who are unaffiliated with other members of their health-care team. This is even in cases where a “health-care team” definitely exists: The study looked at Medicare Accountable Care Organizations (ACOs), which are health-care provider networks that agree to coordinate care in exchange for financial incentives from Medicare to keep costs under control and improve patient outcomes.
Although the study looked at data from 2010 and 2011, right before the ACO program began, its results would probably not be much different using recent data because under the program, patients are given no incentive to stick with providers within the ACO and may not even know they “belong” to an ACO. The study found that among Medicare patients who would have been assigned to an ACO under current criteria in 2010 or 2011, 8.7% of primary-care office visits took place outside the ACO, while a whopping 66.7% of specialist visits took place outside the ACO. Even among ACOs that focus on specialists, 54.6% of patients saw specialists outside the ACO. As a Washington Post blog post on the study notes, unless patients are given incentives to stay within a coordinated-care network, coordination will be difficult.
Do you have a health-care team whose members communicate and coordinate with one another? If so, have you noticed any health improvements as a result? If not, have you had any health problems that might have been prevented or improved through better coordination? Would you be willing to have more restrictions on doctor choice, outside of your primary-care provider, in exchange for better communication among your health-care providers? Should doctors or patients be required to participate in team-based health care? Leave a comment below!