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

12/01/2000

This document is a conceptual framework. It is based upon extensive review of the literature as well as interviews with dozens of experts in measurement of health care quality and health care information systems, clinicians who serve people with disabilities, and people who have studied related fields such as continuity of care, case management and disease management. It is also based on the review of existing projects such as that developed and implemented by the State of Oregon in contracting with Medicaid MCOs.

We begin by discussing the target population for the measurement of care coordination: Whose care needs to be coordinated (Curtis 1999; Gill 1999)? We then move to a discussion of the relationship of the concept of care coordination to related concepts, including coordination in general; case management or care planning; care coordinators; continuity of care; utilization management; disease management or clinical care management; and the structural integration of services. The next sections of the document present the basic conceptual framework, which borrows from the classic distinctions of Donabedian (1980) regarding health care quality: structure, process and outcomes. We "work backwards," beginning with expected long-term outcomes of effective care coordination; moving to intermediate outcomes; going next to processes and activities as well as key factors that will influence the effectiveness of process implementation; and finally specifying structures and other resources that will support and facilitate the implementation of process.

As we have gone through this process, we have found it essential to keep in mind that care coordination is just one dimension of quality. Even the best coordinated care will not serve the needs of people with disabilities and their families, if other important dimensions of quality are not in place, and if resources are not available to make needed medical and related social services available. To some extent, a critical aspect of our task is to set realistic boundaries around the concept of care coordination for purposes of measurement, and to reflect realistic expectations of what care coordination, itself, can and cannot achieve.


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