If you’ve spent time near urban downtown traffic intersections, you’ve likely seen these brave souls…. traffic cops.  Nowadays, of course, traffic police can be spotted near malls, busy school zones and large churches. They are indispensible.

As health care policy experts talk about health care reform, one of the central aims of reform is improving care coordination, and the overriding assumption is that hospitals will be the traffic cops.  Health care’s busiest intersection is the nexus where hospitals, insurers, other health care providers and payers mix together.  It’s a loud and busy place. In the future, physicians will no doubt play a role in care coordination, but hospitals will be deciding when patients need to be released, where they should go for care after discharge, and what the care continuum will look like.  This is all the more likely as an increasing number of physicians become employees of hospitals as part of growth initiatives or due to the fact that they are seeking some level of economic security.

Many health care experts are betting that Accountable Care Organizations will form across the country to manage care coordination.  That’s not necessarily the case everywhere when you consider that setting up an ACO is a complex proposition.

With or without ACOs, my instincts tell me that hospitals will be the central drivers in a new care coordination system.  To operate effectively, though, hospitals will need a more sophisticated system of communications to accomplish their work, meaning integrated voice, IT and patient records systems and channels.

We know the government has pledged to help hospitals upgrade their IT systems to advance use of electronic health records.   The government hasn’t pledged financial support for upgrading phone communications systems and triage networks, leaving that to each hospital to manage.  But this work isn’t merely a technological issue; it’s also an issue of customer relationship management.  How will hospitals maintain connections with patients, payers and other providers so that care is better coordinated?  The same way they do it now?  Let’s hope not.  I say this simply because we’ve seen only limited examples of successful and effective care coordination, primarily in markets that have sole providers in a tight geographical region--Geisinger Health System comes to mind.  The Medicare Advantage program also deploys care coordination teams for some, but not all, of its covered lives.

The real challenge for hospitals that will carry out the job of traffic cop will be setting up the care coordination teams, creating infrastructure to support them, and paying for this new and intense level of service.  Some health systems are large enough to manage this endeavor on their own having the needed staff resources on hand, but my guess is most hospitals are not prepared for the potential scope of this effort.   In terms of the financial implications for this effort, it’s anyone’s guess.

We know care coordination holds the promise of improved health outcomes for many patients, especially patients with chronic illnesses. We believe better care coordination will ultimately generate savings through reduced hospitalizations and readmissions and eliminating duplicative services. Maybe the savings will balance the expense. More often than not, the savings don’t fall to the hospitals, but to the payers.  My hope is that regulatory issues won’t prevent all the parties involved from sharing the savings with hospitals and ultimately the consumers of healthcare themselves.

One consistent theme in the discussions around health care reform is that hospitals are being asked to invest a great deal of their limited resources up front to help fix the system, with the hope and promise that they will reap a legitimate ROI later.  I sincerely hope this is the case.  No sane traffic cop would enter an intersection without a whistle, orange vest and white gloves.  We can’t expect hospitals to perform the vital activities that are linked with care coordination without providing them adequate resources and support.

Jason Wolf

Executive Director - The Beryl Institute