Care coordinators: the key to patient-centered care

March 31, 2016
Care Coordinator Alicia Hanson most enjoys connecting with patients, their family members and caregivers throughout the day.

Care coordinator Alicia Hanson most enjoys connecting with patients, their family members and caregivers throughout the day.

For homebound individuals coping with multiple chronic illnesses, navigating the current healthcare system can be daunting. Even the simplest tasks become complicated as several providers across multiple health systems must communicate and collaborate to get patients what they need. Juggling the orders of specialists, pharmacists, home health providers, insurance companies, caregivers and of course, the patient’s in home primary care provider is a challenge for anyone; especially older individuals who are managing their own or a loved one’s health independently.

Early on, the leadership of Housecall Providers sought to minimize the fragmentation of patient care by incorporating professional care coordinators into our home-based primary care model. Today, care coordination is the nexus that links our primary, transitional, and palliative care programs with the services of Housecall Providers Hospice and a wide range of outside providers.

Experts coordinating in home care

Alicia Hanson, who has been a care coordinator at Housecall Providers for over three years, sees the role as an asset to both the patients and clinicians. “Care coordinators help clinicians provide a consistent and high level of care for patients who otherwise would have no other avenue for receiving the in home medical care they need.”

Alicia is an expert in helping patients get what they need. Her mission, and that of the other six Housecall Providers care coordinators, is to communicate with all members of a care team to ensure that the patient’s needs are being met and services are delivered by the right provider in the correct setting. They strive to ease our patients’ and caregivers’ interactions with the healthcare system, reducing frustration and helping to ensure the best possible health outcomes.

Executing this mission involves a wide variety of daily tasks, from communicating with family members and caregivers about new patient symptoms or requesting prior authorization from insurance companies, to “closing the loop” on referrals to medical specialists by collecting patient visit notes, lab results, and diagnostic information.

Organized, communicative and patient: qualities of a successful coordinator

It’s a busy job; Alicia makes or receives between 50-100 telephone calls each day, in addition to numerous e-mails, faxes, and other messages. “My workflow on an average day is a cycle of answering the phone, sending messages, and returning calls while constantly checking for replies or new messages from my clinicians.”

Alicia attributes her success in this work to an uncommon degree of patience, organization, and perseverance. She works with two to three primary care providers to organize the care of 200 to 300 patients at any given time.

A good care coordinator must be a skilled communicator- able to translate complicated, technical medical orders or convoluted insurance company requirements into terms easy for caregivers or patients to understand, while managing the sometimes overwhelming needs of many patients all within an eight-hour workday.

“The one thing I wish people understood about care coordinating is that I work hard to try to get our patients what they need or want, but there is a limit to what I can do in one day,” she said.

Greatest impact comes from connecting with patients and families

There are so many practical benefits to having a care coordinator that it is easy to overlook the psychosocial support they offer patients and families. Alicia works with people during some of the most difficult moments of their lives- when they or a loved one are struggling with sickness and pain. During these stressful moments, having a person on your side who understands the complicated ‘ins and outs’ of the medical arena can make a huge difference. For Alicia, she feels her greatest impact comes from connecting with the patients and families she serves.

“It’s the little moments – laughing together about something funny that happened during the course of the day, sharing in the relief of getting a much-needed medication, even being able to provide a listening ear and reassurance as family members share their concerns- that mean the most to me.”

– By Mary Finn, Development Coordinator


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