Care coordination, continuum of care
Viewed by many as the future of healthcare and the process that will enable the realization of the triple aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare—care coordination/continuum of care is ranked as the single greatest challenge for clinical quality improvement by 24% of survey respondents.
While reduced reimbursements was the near-unanimous choice as the greatest threat facing organizations (92% chose it), second on the list was physician shortage, cited by 76% of respondents.
Vonderfecht says that the shortage as a threat is only true if "our model for delivering healthcare is the same going into the future as it has been in the past." Moving to patient-centered medical homes and supporting physicians with care extenders will allow physicians to practice at the top of their license and "we may find that we actually have an adequate supply of physicians in most cases," he says.
But sometimes, finding the case managers (also known as care coordinators and nurse navigators) is part of the challenge. Demand for that skill set exceeds supply in some areas thanks to healthcare reform trends in which case managers (usually RNs supplemented by social workers) are integral to population health management efforts and reducing 30-day readmissions.
Ranney explains that as recently as two years ago staffing companies could supply case managers for temporary and permanent work. But today the temp agencies have no one available. According to him, if you have a case manager position to fill, you have to "grow your own" or find the candidates yourself.
Louise Edwards, director of planning and business development for Bon Secours Virginia Health System in Norfolk, concurs that there is big demand for nurse navigators but notes that even hiring from within is becoming more difficult. The seven-hospital system, which is part of the six-state Bon Secours Health System, uses nurse navigators for its cancer program and has been unable to fill an open position for a lung cancer nurse navigator.