The Ankota Healthcare Delivery Management Blog

Care Coordination & Community Based Care Programs

Posted by Will Hicklen on Oct 13, 2011 9:50:00 AM

Johns Hopkins Gazette

"Place, not race, may be larger determinant of health disparities."

"Community-based care models" are emerging rapidly, and this article by Natalie Wood-Wright of Johns Hopkins' Bloomberg School of Public Health underscores one of the reasons why. In community-based models, healthcare professionals bring healthcare to the people, not the other way around. It's healthcare outreach and these groups would do well to study home healthcare delivery to make sure they do it effectively and efficiently.

Example: Rather than hoping that an expectant mother will seek pre-natal care in a clinic (or at greater expense, in a hospital) and follow doctor's recommendations throughout the pregnancy, a community based care model employs a mobile healthcare worker in a home health care model to meet with the expectant mother, educate her on things like nutrition and pre-natal vitamins, and follow up with her regularly to monitor her progress. In such a model, compliance tends to be higher in part because the mother and healthcare provider develop a relationship in the mother's home, taking less time and expense for all, and the occurance of premature births is greatly mitigated. Premature babies are extremely expensive, consuming tremendous resources at the time of birth and for the rest of their lives. It's a simple model that shows terrific financial and health advantages to the familes and health systems alike.

Wood-Wright writes, "Where you live could play a larger role in health disparities than originally thought, according to a new study by researchers from the Johns Hopkins Bloomberg School of Public Health."

"Thomas LaVeist, lead author of the study and Director of the Johns Hopkins Center for Health Disparities Solutions and the William C. and Nancy F. Richardson Professor in Health Policy and Management at the Bloomberg School states, “By comparing black and white Americans who are exposed to the same set of socioeconomic, social and environmental conditions, we were better equipped to discern the impact of race on health-related outcomes and have concluded [that] social factors are essentially equalized when racial disparities are minimized."

While the study originated in a group at Johns Hopkins Bloomberg School of Public Health that seeks to understand disparities in health among racial groups, a key finding is that where you are has more to do with your health and access to care than your race.

This post is not intended to weigh in on disparities in rate of disease or access to health care among races or ethnicities. Moreover, this post is intended to illuminate the fact that location--geography--has a tremendous impact on the health and well being of populations. Understanding where diseases occur as well as why they occur can allow Johns Hopkins and other health systems to design community based care programs that make an impact, improving the health of the populations they serve and reducing overall costs to the system.

Community based care models are driving the need for more advanced Care Coordination among providers and technology to enable it. Technology must address new complexities that are introduced with scheduling, route planning and mobility requirements. Community Based programs present great opportunities for providers to cooperate and deliver better services at lower costs. Home Health care agencies must coordinate with hospitals, and other services and systems must be developed to support coordinated networks of providers. Providers can expect that factors such as this and the rise of Accountable Care Organizations (ACOs) will drive the need for new technologies such as Ankota's XChange Care Coordination Portal.

To learn more about Care Coordination technology, Community Based Care Models, or Ankota's XChange Care Coordination Portal, visit http://www.ankota.com/care-coordination/

Topics: Care Coordination, transitional care, Will Hicklen

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Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

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