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A focus on coordinated care.

Byline: Patrick Hughes

In health care, coordination is the new black.

The push to control costs is blurring the lines that have made up the health care landscape for decades. Doctors and hospitals are being asked to share the financial risk of caring for patient populations. Health plans, already experienced in managing large populations, are becoming providers. Hospitals are consolidating to achieve economies of scale. Physician groups are becoming free agents, ending traditional alliances and making new ones as they seek arrangements that make economic sense.

For consumers, this changing landscape can look confusing, even chaotic. Their familiar network of doctor, hospital and health plan is breaking up, creating disruptions and forcing them to make hard decisions.

Consumers are also being asked to share a greater financial responsibility for their medical choices so they have a stake in controlling costs. They are being flooded with new information intended to help them make educated decisions but which may seem overwhelming.

Change is inevitable, but the goal should always be coordinated care. Why? Because evidence shows it both reduces costs and improves clinical outcomes.

In this brave new world, health care organizations that offer the most value will be those which offer consumers the most seamless coordination -- a single point of contact, all-inclusive care and even non-medical support services, from exercise programs to transportation to a doctor's office, that promote better health.

Because of the costs associated with our aging population, the federal Medicare program has been a major focus of innovative efforts to promote coordination, and Fallon Community Health Plan has been at the forefront of those efforts.

FCHP is the only health plan in the country to operate a Program for All-Inclusive Care for the Elderly. Called Summit ElderCare, FCHP's PACE provides a team of geriatric social workers, nutritionists, rehab specialists, home health care staff, and doctors and nurses to oversee an elder's care at home or at an adult day center.

FCHP also operates a Senior Care Options plan, called NaviCare, which similarly provides all-inclusive care to seniors who are eligible for both Medicare and Medicaid. And recently, FCHP was chosen by the state to operate a similar program (Fallon Total Care) for other populations including those with intellectual and developmental disabilities.

The evidence shows that these programs are working to reduce costs and improve medical outcomes. A study commissioned by the state found that SCOs are saving money by reducing nursing home admissions, while a University of Massachusetts Medical School study found high patient satisfaction with SCOs.

Coordinated care works so well that we have brought those lessons to some of our other products, such as Fallon Senior Plan, our Medicare Advantage product. One example is a program in which members with complex medical issues are supported by a primary care team. The team collaborates with the member's primary care doctor and works together to make sure the member's social, physical and medical needs are cared for in a timely manner.

It may be fashion forward now, but coordination is on the way to becoming fashion mainstream.

Patrick Hughes is the president and CEO of Fallon Community Health Plan.
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Title Annotation:Editorials
Author:Hughes, Patrick
Publication:Telegram & Gazette (Worcester, MA)
Date:Oct 11, 2013
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