Date: 12/21/2017

Author(s): Clese E. Erikson, Patricia Pittman, Alicia LaFrance, Susan A. Chapman

 

Highlights Value-based payment is leading to enhanced care coordination staffing. Sites are task shifting low-complexity care coordination to unlicensed staff. Important care coordination education gaps necessitate in-depth on-the-job training. Demonstrating the return on investment of care coordination staffing remains a challenge. Background Care coordination is generally viewed as a key to success for health systems seeking to adapt to a range of new value-based payment policies. Purpose This study explores care coordination staffing in four health systems participating in new payment models, including Medicaid payment reform and Accountable Care Organizations. Methods Comparative case study design is used to describe models of care coordination. Analysis of 43 semi-structured interviews with leadership, clinicians, and care coordination staff at four health systems engaged in value-based contracts. Discussion Each of the sites engaged in significant task shifting of low-complexity care coordination activities to licensed practical nurses, medical assistants, and other unlicensed personnel freeing up registered nurses and social workers for more complex patients. Few have care coordination experience, requiring a significant investment in on-the-job training. Conclusion Payment reform is leading to a greater investment in the care coordination workforce. However, demonstrating the return on investment remains a challenge.