Patient care coordinators: successfully merging utilization management and discharge planning

Area of Science:

• Healthcare Administration
• Patient Care Coordination
• Health Services Research

Background:

• Facilitating patient-focused, cost-effective care across the healthcare continuum presents significant challenges for administrators.
• Effective communication and linkage among diverse stakeholders (providers, payers, families) are crucial for optimal patient care.
• Existing models may not adequately integrate utilization management and discharge planning functions.

Purpose of the Study:

• To describe the development and implementation of the patient care coordinator (PCC) role at Children's Hospital, Boston.
• To illustrate the goals and intended outcomes of the PCC role in improving healthcare delivery.
• To provide a model for enhancing interdisciplinary communication and care coordination.

Main Methods:

• Development of a novel unit-based leadership role, the patient care coordinator (PCC).
• Integration of utilization management and discharge planning functions into a single role.
• Qualitative description and outcome illustration through case examples.

Main Results:

• The PCC role was established to bridge communication gaps between healthcare providers, payer organizations, and families.
• The role aims to streamline care processes by consolidating key management functions.
• Examples demonstrate the practical application and potential benefits of the PCC model.

Conclusions:

• The patient care coordinator role offers a creative solution for improving patient-focused, cost-effective care.
• Integrating utilization management and discharge planning can enhance care coordination and stakeholder linkage.
• This model has the potential to improve communication and efficiency throughout the patient care continuum.