Interview: Care Coordinators Improve Care Quality

Lori Francis, MBA, PCMH CCE, a program management specialist at BlueCross BlueShield recently spoke with First Report Managed Care at Health Care Quality Congress 2019, on the benefits of using embedded care coordinators to improve physician and payer partnerships.

Please introduce yourself.

I’m Lori Francis. I am the program management specialist for BlueCross BlueShield’s patient-centered medical home program. Before I came to BlueCross, I worked in a primary care and a family practice clinical residency program. I helped facilitate the patient centered medical home model and with its NCQA recognition, as well as working in other quality areas.

I work with our contracted medical practices in our patient-centered medical home program and help them achieve their NCQA recognition, quality improvement, improving their processes and workflows, and integrating anything that we can to help them better achieve their goals.

Can you highlight some of the benefits of utilizing embedded care coordinators?

Embedded care coordinators provide a really unique opportunity because they are in the practice. They are on the ground floor in the clinics and working with physicians. They can see the patient when they come in, and they can talk with them on the phone.

They help connect with community resources, as well as address socioeconomic concerns and barriers to care that patients and physicians face.

Many patients or members, may not be able to afford their medication. Our care coordinators can go out and make phone calls, conduct research, locate and secure the resources that patients require to get their medication. In some cases, embedded care coordinators are able to connect patients with a specialist more efficiently than the practice can.

They’re an intricate part of the practice. Many organizations and practices face challenges like financial feasibility, space, and qualified professional staff when trying to develop an effective and efficient care coordination program. Embedded care coordinators can assist in addressing those challenges, as well as help identify and close gaps in care and instill change to help practices improve their HEDIS scores.

What advice would you give other health care professionals who are trying to integrate care coordinators into their partnerships?

First, health care facilities and physicians alike should look at their quality metrics, develop a QI plan, and involve the key stakeholders to determine what areas you need to improve in. Begin the process by examining a small patient population and learning what areas can be improved.

Focusing on a small population gives you an opportunity to pilot programs and see the potential outcomes, as well as plan for changes more effectively. Small patient population pilots will give practices a chance to look at their HEDIS measures and see where embedded care coordinators can make the most significant impact to improve their HEDIS measures. —Edan Stanley