Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. C. Care Coordination And Care Coordinators

12/01/2000

The simplest way to measure care coordination, but by no means the most appropriate, would be to simply ask and answer the question "Does the MCO have care coordinators that are assigned to members with disabilities?". Indeed, a frequent "knee-jerk" reaction to a need for care coordination is to hire or identify people as care coordinators. Many assume, for example, that care coordination is a distinct service, provided by care coordinators. While this may be true, we would argue that while the identification of appropriately educated and trained individuals as "care coordinators" is (at least now) necessary to achieve care coordination, it is by no means sufficient (Donaldson, personal communication). The need for care coordinators is reflected in how many people with disabilities, their family members, and their clinicians, point to the great need for "a single person" who can be, at a minimum, a central point of contact especially, but not exclusively, in times of crisis, and who can amass, over time, a very detailed and nuanced understanding of the particular individual and their home and community context. This "single person," it is stressed, must have a similar intimate knowledge of the MCO itself and of resources in the community beyond the MCO (Bennett 1997; Cocotas, personal communication; Goldberg, personal communication).

But for care to be coordinated efficiently as well as effectively, a care coordinator is not enough. At the organizational level, mission and commitments, relationships with external entities, information systems, financial arrangements, and relationships with providers will all make a difference (Goldberg, personal communication; Sofaer1994). At the provider level, understanding of persons with disabilities, recognition and appreciation of the role of care coordination, willingness and ability to share information, all will make a difference. So the definition and, ultimately the measurement of care coordination, must go substantially beyond the mere presence of care coordinators (Leutz, personal communication).

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