NURS FPX 6612 Assessment 4 Cost Savings Analysis

Health information technology (HIT) involves the storage and exchange of health information in an electronic environment. Not only does it increase the productivity of a health sector by effectively managing information, but it also improves the quality of health care and health outcomes for the patient. According to a study done in 2018, HIT has the potential to reduce healthcare costs by more than $77 billion (Pearson & Frakt, 2018). The largest savings can come from reduced hospital stays, more efficient drug utilization, and a decrease in nurse turnover rates. This article will further explore ways in which care coordination generates cost savings, how it promotes positive health outcomes, and the way in which it improves quality through a particular healthcare model. A spreadsheet of cost savings over the course of one fiscal year will also be discussed.

Care Coordination Generates Cost Savings

Care coordination involves patient care activities and sharing health care information to achieve safer and more effective care. The main goal of care coordination is to meet the patient’s healthcare needs while ensuring high-quality care is being provided. Examples of care coordination activities include establishing accountability, communicating and sharing knowledge, assisting with transitions of care, assessing patients’ needs and goals, creating a care plan, monitoring and following up in response to patients’ needs, and supporting patients’ goals.

Implementing care coordination in health care has been shown to reduce costs. For example, formulating a care plan using a patient-centered approach will ensure that patients are not readmitted to the hospital due to a lack of care. For example, if a diabetic was treated in the hospital for elevated blood glucose levels, and the care plan requires the patient to check blood sugar before every meal and at night, but their insurance does not cover the glucometer, and they are unable to pay out-of-pocket, then most likely, they will not be able to follow through with the orders. In this care, the interdisciplinary team can work on switching the patient to another insurance company, such as Medicare or Medicaid, in order to have the glucometer covered. This will ensure that the patient is compliant with all discharge instructions.

Another example in which care coordination generates cost savings is the efficient transition of care. The transition of care is the movement of a patient from one setting of care to another. It is comprised of patient teaching on self-management, medication reconciliation, home rehab services, and psychosocial support. For example, a patient that was admitted to the hospital for a fall may transition out to rehab for further care. Interdisciplinary communication is important in this scenario to ensure that tests are not being repeated and the plan of care is being followed (Kripalani et al., 2019). This will reduce costs by preventing hospital readmissions, as well as improve patients’ health outcomes.

Studies have shown that care coordination can improve cost savings by up to $296 per patient per month (Khullar & Chokshi, 2018). Nurses use a patient’s electronic health record (EHR) to communicate with different healthcare agencies in order to begin the process of transitional care. In this particular scenario, a CarePort platform was implemented in order to track patients across the healthcare system (Khullar & Chokshi, 2018). When a patient leaves a particular facility, their provider is notified immediately in order to begin scheduling follow-up care. This service will automatically send a recorded message to the patient to remind them to schedule a follow-up appointment. This is a great way to keep patients on track with their discharge plans and aim to improve health outcomes.

NURS FPX 6612 Assessment 4 Cost Savings Analysis

Care Coordination Promotes Positive Health Outcomes

Care coordination has the opportunity to impact the healthcare system as a whole while improving quality healthcare and better health outcomes for patients. As the aging population grows, more care is needed. This becomes difficult with the shortage of health care providers. Having a care coordination team to address the healthcare needs of a patient can, in turn, promote positive health outcomes. Some examples of care coordination activities that promote positive health outcomes include medication adherence, follow-up after healthcare procedures, and supporting health and wellness goals.

Medication adherence is a vital part of promoting positive health outcomes. By doing so, patients are able to better manage their diagnoses at home rather than requiring medical care in the hospital. For example, it is important for a diabetic patients to adhere to their medication regimen in order to prevent diabetic ulcers and increased blood pressure, which may require further medical treatment. Preventing hospital admissions will reduce the number of hospital-acquired infections (HAI), as well as anxiety and depression.

Ensuring that patients attend follow-up appointments as scheduled is vital to improving patient outcomes. The two primary benefits associated with follow-up care are reduced hospital admissions and healthier patients, which drives positive outcomes. Regular post-discharge follow-ups allow providers to monitor patients’ ability to manage their care outside of a healthcare facility. By doing so, they are able to catch complications early, which can result in a better prognosis. Reduced hospital admissions also have a positive financial outcome for healthcare organizations.

NURS FPX 6612 Assessment 4 Cost Savings Analysis

Care Coordination Improves Quality Through a Health Care Model

There are many ways in which care coordination efforts can enhance the collection of evidence-based data and improve quality through the application of healthcare models. Studies have shown that integrated healthcare delivery improves the performance of health systems by increasing patient satisfaction and improving the quality of care. Integration is achieved by coordination among healthcare providers whose aim is to achieve continuity of care in order to address the healthcare needs of their patients.

The Rainbow Model of Integrated Care (RMIC) is a measurement tool that allows for an inclusive evaluation of integrated care across all levels of a healthcare system and is based on primary care tenets which outline four dimensions of integrated care (Fares et al., 2018). Those dimensions include clinical integration, professional integration, organizational integrational, and system integration. These four dimensions specifically illustrate how care coordination efforts can enhance the collection of evidence-based data and improve healthcare quality for all patients. Clinical integration involves the extent to which person-centered care is coordinated. Not only does this boos the effectiveness and efficiency of care, but it also promotes innovation, expands healthcare coverage, and reduces costs. Professional integration involves the sharing of roles and responsibilities among members of the interdisciplinary team (Fineide et al., 2021). This ensures that all team members are familiar with their roles and responsibilities in order to effectively meet a patient’s healthcare needs without any complications. Organizational integration involves collaboration through contracting and alliance. This involves creating a framework with structure, knowledge development, and information exchange in order to enhance collaboration and help coordinate services (Fineide et al., 2021). System integration involves the linkage of healthcare services through policies (Fares et al., 2018). This will provide excellent performance in terms of quality and safety as a result of effective communication and standard protocols. Last but not least, RMIC aims to improve health care quality for all patients by using state-of-the-art information systems to collect, track and report data. This efficient information system not only enhances communication but also allows information to flow across the continuum of care (Fares et al., 2018).

NURS FPX 6612 Assessment 4 Cost Savings Analysis

Cost Savings Data

The United States spends more on health care than any other country. Over the years, studies have estimated that approximately 30% of healthcare spending may be considered waste (Shrank et al., 2019). In the table below, the estimated costs versus the potential for savings are depicted based on three domains: failure of care delivery, failure of care coordination, and overtreatment.

	Estimated Costs	Potential for Savings
Care Delivery	$102.4 billion – $165.7 billion	$44.4 billion – $97.3 billion
Care Coordination	$27.2 billion – $78.2 billion	$29.6 billion – $38.2 billion
Overtreatment	$75.7 billion – $ 101.2 billion	$12.8 billion – $28.6 billion

Table 1

Conclusion

Care coordination in health care has the ability to reduce waste-related costs and improve the quality of health care for all patients. To summarize, formulating a care plan using a patient-centered approach will prevent hospital readmissions, and the use of an electronic health care record will allow for effective communication among providers. Successful measures must be taken to eliminate wastes, which will reduce the continuous increases in the United States’ health care expenditures.

References

Fares, J., Chung, K., Passey, M., Longman, J., & Valentijn, P. (2018). Exploring the psychometric properties of the rainbow model of integrated care measurement tool for care providers in Australia. BMJ Open, 9(12).

Fineide, M.J., Haug, E., & Bjorkquist, C. (2021). Organizational and professional integration between specialist and primary healthcare services: A municipal perspective. International Journal of Integrated Care, 21(2).

Khullar, D. & Chokshi, D.A. (2018). Can better care coordination lower health care costs? JAMA Network Open, 1(7).

Kretchy, I.A., Asiedu-Danso, M., & Kretchy, J. (2021). Medication management and adherence during the Covid-19 pandemic: Perspectives and experiences from low-and middle- income countries. Research in Social and Administrative Pharmacy, 17(1), 2023-2026.

Kripalani, S., Chen, G., Ciampa, P., Theobald, C., Cao, A., McBride, M., Dittus, R.S., & Speroff (2019). A transition care coordinator model reduces hospital readmissions and costs. Contemporary Clinical Trials, 81(1), 55-61.

Pearson, E. & Frakt, A. (2018). Administrative costs and health information technology. The JAMA Forum, 320(6), 537-538.

Shrank, W.H., Rogstad, T.L., & Parekh, N. (2019). Waste in the US health care system: Estimated costs and potential for savings. JAMA, 322(15), 1502-1509.

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Question

Prepare a spreadsheet of cost-saving data showing efficiency gains attributes to care coordination over the course of one fiscal year, and report your key findings in an executive summary,4-5 pages in length.