medicalHospitals and social service agencies are set-up to handle specific medical or social issues but rarely do they consider the interaction between these two disciplines. However, it is possible and beneficial to integrate the two. What is the best way to accomplish this? Why is it so important? First consider that 40 percent of all Medicare expenses occur during post-acute care. This is treatment following an acute episode such as a coronary event or hip replacement. Well-managed post-acute care has been shown to reduce healthcare costs dramatically while producing better results, as well as significantly reducing the financial burden on families and loved ones. The Affordable Care Act focuses some attention on this area, one of which is funding for experiments to more efficiently manage post-acute care.  We recently started working with one of the experiments involving the use of a “care coordinator” to bridge the medial and social sides of recovery. Care coordinators work with the hospitals, the patient, that patient’s caregiver, rehab facilities, home care and other service providers to create a coherent recovery plan. Care coordinators must understand a broad range of issues and be able to influence and align all of these constituencies. This is a demanding and frustrating job with high burnout and turnover rates, complicated by the fact that care coordinators often have different motivations and incentives. We were involved with a similar program a few years ago which focused on non-medical case management in emergency departments (ED). Half of ED costs come from people with co-occurring conditions meaning, they had at least two major issues such as addiction or homelessness. The ED case managers usually ended up doing many of the same things as care coordinators, often in the face of incentives to protect their own interests. Unfortunately, these programs have not proved to be as effective as they should be. In both cases, care coordinators and their management teams got so caught up in surviving daily pressures that that they lost sight of the bigger picture. When that happened, it was only a matter of time before frustration set in and turnover soared. In spite of ineffective management teams, there were exceptions: the stars. As we discovered, the stars loved their role and were extremely effective and productive. The stars did something different from the others, they took care of themselves. They spent time reflecting on their purpose and how they were performing their tasks. They did this by taking a brief break (about five minutes a day) to pull out of the transactional pressures and think about their health and well-being. When we suggested this practice to management, they resisted because they felt there was too much to do. But as we found from talking to the stars, such a practice is well worth the effort and minimal amount of time it would require. In the case management example, star performers cut undesirable ED visits in half, resulting in economic benefit and improved social well-being for patients. Care coordination and case management is about helping the system become efficient. The key to that is taking the time to work smarter not just harder and to connect to the real purpose of helping those in need. This is a valuable lesson that has the power to benefit us all.]]>

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