Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. VII. WHAT ORGANIZATION/STRUCTURAL FACTORS APPEAR CRITICAL TO EFFECTIVE AND EFFICIENT CARE COORDINATION?


Many authors suggest that it is not enough for a particular set of processes or activities to be implemented consistently. They note that howthey are implemented makes a difference, and that the consistence and appropriateness of implementation will also be affected by certain, relatively intangible factors, which relate largely to the attitudes and beliefs of providers and MCOs (Saltz 1996; McManus 1997; Curtis 1999; Regenstein 2000; Schneider 2000). Although we frankly quail at the thought of attempting to measure such factors, except through reports from patients, providers and family members, we believe our conceptual framework would be incomplete without identifying them:

  1. Leadership by the state Medicaid agency in convening stakeholders to identify the goals and scope of care coordination efforts.

  2. Shared recognition (by state Medicaid agency, MCOs, providers, patients and families) of goals and potential benefits of care coordination.

  3. Recognition by providers, and by the MCO, of the impact of the life and community context of patients on their goals, preferences, health and functioning.

  4. Ongoing and meaningful communication between patients/families and providers, and across providers caring for the same patient or group of patients.

  5. Trusting relationships between patients/families and providers, among providers, and between those identified as responsible for care coordination and both patients and providers.

  6. Willingness of health care system actors to work collaboratively with professionals and agencies from other sectors, and vice versa.

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