Care coordination: infrastructure to support health

The health industry has long recognized the need for care coordination, as organizations and national and local agencies continue to push the need for connected care across medical health, behavioral health and social determinants of health to address health equity issues, improve health outcomes and curb excessive spend. However, the absence of an industry-wide infrastructure and the lack of clarity around who delivers what care coordination services have prevented widespread successful execution and meaningful impacts.

Creating a human-centric enterprise strategy

Moving forward, health organizations must define their own robust infrastructure rooted in holistic consideration of member and patient needs and the larger health ecosystem to support meaningful care coordination programs.

An enterprise-level human-centric strategy provides the critical foundation for this robust infrastructure. This strategy should consider the organization’s unique characteristics, such as patient or member population profile and member or patient interaction modalities, and define:

• Criteria for identifying populations to target (e.g., by cost, diagnoses, post-discharge).
• What care models to deploy (e.g., in-person, telehealth).
• What types of care coordination issues to address.
• What to do to address those issues.

A robust framework can help address two program design flaws that commonly lead to inefficiencies:

• Siloed programs that target the same individuals.
• Funded programs that do not have tangible work that can be performed or tracked.

A health organization should then evaluate its population and other health care organizations within the ecosystem to:

• Validate alignment of offerings with member or patient desires or needs.
• Prevent duplication of already provided services.
• Expose opportunities for strategic partnerships, such as among other health organizations that share members or patients and third-party vendors that specialize in providing specific services.

A blueprint and operating model for healthier outcomes

A blueprint for a coordinated care program’s business and IT infrastructure, which stress-tests the operational feasibility of strategy execution, is the next key step in designing for success. Much like a blueprint for building a home, this provides guardrails for future detailed requirement definition and includes:

• Designing a system-agnostic conceptual model to underpin operating model design, including types of issues addressed for target populations and high-level workflow definition. 
• Evaluating the data and technology infrastructure to identify high-level data infrastructure needs, including needs around enterprise data mining, data architecture needs and a care coordination platform.

Once the program strategy and blueprint are defined, the organization should establish governance to define the operating model and align people, process, technology and data. The governance structure should include an executive-level business IT leadership team that monitors strategy alignment and provides final approval for design.

Dedicated enterprise-level architecture resources who can define the program blueprint and lead operational design are critical to successful program design and execution. These resources should be fully dedicated to design and are distinct from day-to-day process owners (i.e., subject-matter resources) who consult on design and review and approve proposals. This enterprise-level architecture approach has several benefits, including:

• Allowing process owners to maintain primary focus on day-to-day business oversight, instead of program design.
• Preventing over-engineering by siloed business units.
  
  
• Fostering the implementation of enterprise best practices.
  
  
• Preventing over-resourcing (both in number of resources assigned to a member or patient and cost of resources).
  
  
• Promoting data integrity (e.g., standard use of fields for data capture, mutually exclusive values).
  
  
• Enabling data-informed decision-making when re-evaluating organizational strategy.

After implementation, organizations should continue to monitor performance, evaluate the external health ecosystem and centrally manage program design updates to maintain program efficacy and efficiency. To do this, the organization needs to establish an ongoing governance structure to enable oversight across five key components: