Speaker 1: With the transition to value-based care, health care providers are facing new challenges to meet specific performance metrics and bring value to the care they provide. They're turning to integrated care coordination as a holistic solution to answer these challenges. But what exactly does that entail? In this video, we're going to discuss care coordination and walk through its four components so that you can get a better understanding of how it can improve the value-based care that you provide. Hey, this is Dan from ThoroughCare. At ThoroughCare, we've assisted clinics and physician practices across the United States as they transition to value-based care through an overall focus on care coordination. Care coordination offers a broad response to the challenges inherent to value-based care. We're going to discuss four core features of care coordination to give you an understanding of its goals and some of its practical applications for you and your patients. But first, let's talk a little about what care coordination is. Care coordination is a means to help engage your patients and streamline their care activities. It involves organizing your patients' various needs as they go between multiple providers. The overall goal of care coordination is to enable a more holistic, personalized approach while reducing costs and negative outcomes through increased efficiency. Care coordination consists of four core components as we see them. The first component is a holistic understanding of a patient's health needs. To provide effective care coordination, you'll need thorough information about your patient's conditions, health goals, and the interventions or activities they're undertaking. All coordination efforts will be based on information which makes this an opportunity to tailor your patient's care experience. A patient-centered care plan can help gather all pertinent health information. A care plan allows you to assess a patient's priorities and then personalize treatment by having a patient answer a series of questions and provide medical history through a simple assessment. The result is a concise report that helps isolate a patient's primary concerns or goals. A patient-centered care plan is ultimately the backbone of integrated, coordinated care. The second component is streamlined access to care services and providers. Once a care plan is established, it will help guide the next best actions and streamline access to care services and providers. Services will vary based on patient needs, but ideally, access to specific programs or specialists should be streamlined. A patient-centered care plan can help focus specific care goals and promote preventive health program participation. In doing so, care coordination should promote a continuum of care outside a practice office or hospital and into the home. One such home health solution is remote patient monitoring, or RPM. This is a value-based care program that enables remote vital capture through various digital devices. This program can benefit a patient's health by capturing patient data in real time. Providers can then analyze this information to help inform targeted interventions or care decisions. RPM and other preventive care programs work with and support the core objectives of care coordination. These programs can inform a personalized care experience while helping to improve efficiency for both the practice and the patient. The third component is concise, actionable information to support patient engagement. Patient engagement is a key performance metric for value-based care and it's an integral part of care coordination. Engaged patients are more likely to track their progress and maintain their treatments, which can lead to improved health outcomes, especially for chronic disease management. As a provider, you're now tasked with making care services more transparent, more useful, and ultimately more valuable for your patients. Communicating clear, useful information is one way to do so, including information about care interventions, tasks, and medications. This invites your patients into the overall process while ensuring you and those you serve are on the same page. It builds trust and it promotes efficiency. It can encourage additional effort from your patient as well as reduce potential confusion. Some providers utilize mobile patient apps to engage and inform, whereas other practices rely on care managers to conduct direct outreach by phone or through digital chat tools. The fourth and last component is strong communication to help coordinate care transitions. Care coordination aims to support a continuum of care. This can encompass primary, acute, and long-term health services that occur in various settings, whether in a hospital, your office, or even the patient's home. No matter where a patient is in the continuum of care, care coordination helps to ensure quality, efficacy, and efficiency throughout their care. This can support improved outcomes while reducing costs, which are key aims of value-based care. One way that you can apply the concepts to drive care coordination is another program called Transitional Care Management, or TCM as we'll refer it to. The program places emphasis on a strict timeline in which you or your care team are expected to inform and connect with patients by specific follow-up dates as well as coordinating services between providers and specialists. Strong communication enables effective coordination and engagement. So, those are the four core elements of care coordination. And as you can see, care coordination shows promise in addressing the goals of value-based care. It's most effective to implement care coordination with actual programs and services that incorporate the four components that we've detailed, including programs that we mentioned in this video, as well as other value-based care programs like Chronic Care Management. If you'd like to learn more about these programs, you can watch other videos on our channel or visit our Learning Center where you can find out more information about these programs as well as care coordination. If you're interested in how a care coordination software solution can help you to implement these solutions, contact us at the link below. A thorough care rep can answer any of your questions. If you liked this video, be sure to like it below and subscribe. Thanks for watching. Bye. .