Care coordination is crucial when it comes to providing patients with high-quality home healthcare. As they navigate an intricate network of providers, specialists, and services, effective care coordination ensures that every aspect of their care is well-integrated and seamlessly managed so that patients can remain in the comfort of their homes.

By prioritizing communication, collaboration, and comprehensive planning, Assisting Hands West Houston provides clients with expert, personalized care coordination that leads to better health outcomes and enriches their quality of life.

What is Care Coordination?

Care coordination is the organization of a patient’s care and medical information across multiple healthcare providers, the patient, and the patient’s family and caregivers. The goal is to ensure that patients receive high-quality and timely care across their team of healthcare providers. Successful care coordination involves clear communication and teamwork. 

Why is Care Coordination Important?

When healthcare providers collaborate effectively, a patient’s needs are communicated to the right people at the right time, leading to appropriate and efficient care. As a key strategy in healthcare, care coordination:

• Improves patient outcomes: When care is well-coordinated, all aspects of a patient’s health are addressed and fewer medical errors occur. Essentially, the patient’s quality of care increases. 
• Lowers healthcare costs: By coordinating care, providers can prevent redundant tests and procedures. Plus, care coordination leads to fewer hospital readmissions. This ultimately reduces unnecessary out-of-pocket healthcare expenses.
• Prevents vital information loss: Referral staff deal with many different providers, so loss of patient information can occur. With its emphasis on clear communication, care coordination helps prevent records from getting lost.  
• Eliminates disjointed, or fragmented care: Lack of coordinated care leads to negative patient outcomes. Chances are higher for repeated tests, more doctor visits, medication and other medical errors, more use of emergency care, and poor transition care from hospital to home.
• Promotes teamwork/collaboration: Care coordination involves ongoing communication between the primary care physician (PCP) and any specialists. Specialists will receive clear reasons for the referral from the PCP as well as any other relevant patient information. The PCP will receive information from the specialist about the referral in order to update ongoing treatment plans.

When is Care Coordination Needed?

Care coordination is necessary in situations where patients require multiple healthcare services or providers. Here are some examples of when care coordination is needed:

• Chronic disease management
• Complex medical conditions
• Post-surgical care
• Transition of care (from hospital to home or from one care setting to another)
• Follow-up after emergency care
• Senior assistance and care

What Care Coordination Entails

Care coordination involves assessing a patient’s needs in order to develop a comprehensive care plan. Some other activities include:

• Utilizing electronic health records
• Educating patients on self-management
• Providing transportation services
• Coordinating doctor’s appointments 
• Connecting patients to community-based programs

At Assisting Hands West Houston, our care coordination involves an initial assessment by our Care Coordinator, a determination of benefits, and the development of an ongoing Plan of Care.

Initial Assessment

Our Care Coordinator visits each client at their place of residence to evaluate their condition, discuss options, and develop a Plan of Care suited to their needs.

Benefit Determination

We help identify any programs, community resources, or benefits that might be available for our clients, such as: 

• Medicare/Medicaid Services 
• Private Health Insurance
• Long-Term Care Insurance 
• VA pensions 

Development and Ongoing Plan of Care

Development of the Plan of Care can begin before the patient is discharged from the hospital, rehab, or other healthcare facility. We work with the attending physician, discharge planner, family, and the patient to determine the proper Plan of Care and agree on the specific goals to maximize the healing process.

To create the Plan of Care, we incorporate the orders and recommendations from your physicians, case managers, healthcare providers, and our own initial assessment. This plan will describe:

• Required healthcare services
• Proposed frequency of services and treatment
• Cost of each service
• Potential equipment and supplies needed
• Possible payment sources

Assisting Hands West Houston Can Assist with Coordination Care

Assisting Hands West Houston can help. Our Care Coordinator is trained to assist with providing the care your loved one needs in the comfort and safety of their home. Call us at (281) 369-5858 or message us by clicking on the chat box on the right.