Care Coordination and Magical Thinking

One myth that has been promulgated has been that care coordination will lead to cost containment. A commentary on this topic (JM McWilliams. NEJM 2016; 375: 2218-20) explains the fallacy of this thinking.  While care coordination can improve medical care, “conflating cost containment and care coordination poses many potential dangers.”  Good care is worthy goal even in the absence of saving money.

Key points:

  • Care coordination often improves outcomes but typically involve interventions to correct underuse of care
  • For every costly complicated prevent, “a care coordination program must manage care for multiple patients…[which] is costly.”
  • Early evaluation of care coordination in accountable care organizations (ACOs) have shown the efforts “have meaningfully improved patient experiences but not rates of hospitalizations for ambulatory care-sensitive conditions.” There has not been evidence of fewer readmissions or fewer preventable hospitalizations with care coordination.
  • Other strategies to reduce cost are now being targeted, like steering patients to lower-priced providers

My take (from author): “We should coordinate care not to save money but because coordinated care is better care.”


Yellowstone (I took this picture!)


One thought on “Care Coordination and Magical Thinking

  1. “Steering patients to lower priced providers”……just the concept of low price and high price providers is a bit scary. These systems often don’t or can’t account for the acuity of patients being cared for. If your a specialist who takes care of sick patients there are costs involved and I doubt insurers can accurately account for these matters. Additionally, large centers or multi-specialty groups will argue they take care of the sickest patients, but that isn’t always true either. Smaller practitioners and private groups will argue they have easier access and more immediate results, but are they using the most cost effective techniques.

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