Care coordination helps keep members satisfied and engaged with their health care
Tips for improving care coordination:
- Engage in meaningful conversations. Start by discussing the importance of sharing relevant information and medical history with patients. Ask if they have seen any other physicians or other providers, including their primary care physician (PCP), since their last visit with you. Obtain their consent to request records or treatment plans from these other providers.
- Follow-up after inpatient stays. After a member has been hospitalized, promptly follow up to see if they need any further support during their transition back to the community.
- Respond timely to information requests. When physicians or other providers request information about your patient, respond promptly. This ensures continuity of care, reduces the risk of redundant testing, and facilitates accurate diagnosis and treatment.
- Share comprehensive information. When referring a member to another physician or other provider, share all relevant information, even if the diagnosis is preliminary. This helps the receiving provider understand your considerations and supports their own diagnosis and treatment planning.
- Exchange assessment results. After receiving the member’s consent, share the results of any assessments, including diagnoses and treatment recommendations, with their other physicians or providers. Aim to do this within a week to ensure timely care.
- Consider case management. For members with complex medical or behavioral health conditions who may be seeing multiple physicians or other providers, consider referring them to case management. Case management can help coordinate care and improve communication among all providers involved.
- Clarify screening tool results. If you administer any screening tools, inform members when they can expect to receive their results. If delays occur, keep them updated and ensure they know the best method to contact you—whether by phone, email, or member portal.
Improving care coordination in behavioral health
Timely exchange of information for coordination of care includes the sharing of information with other treatment team members and is a critical part of responsible practice. Sharing information with other physicians or providers may not be necessary in all situations, but is important if the member has any of the following conditions:
- Is taking prescribed psychotropic medications.
- Has reported a concurrent medical condition.
- Has a substance abuse disorder1.
- Has a major mental illness (other than an adjustment disorder).
- Was referred by their PCP or other medical practitioners, or if the PCP will be following the member for psychotropic medications.
Encourage members to sign the appropriate authorization forms so pertinent information can be released back to the member’s PCP as needed. Even if authorization isn’t needed at the present time, a signed authorization form on file may prove helpful in the future.
1Federal regulations (42 CFR Part 2) restrict disclosure of confidential substance abuse diagnosis or treatment information without member consent.
