NURS FPX 6612 Assessment 4 Cost Savings Analysis

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Capella university

NURS-FPX 6612 Health Care Models Used in Care Coordination

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Date

Cost Savings Analysis

Care coordination refers to collaborating among various healthcare professionals to organize and implement patient care activities and sharing information to provide safe and effective patient-centered care. It is a crucial component of healthcare management that aims to ensure that patients receive appropriate care at the right time and in the right setting (CMS, n.d.). This assessment presents a cost-savings analysis for Miami Valley Hospital, where I work as a senior care coordinator. This report aims to identify the impact of care coordination using Health Information Technology (HIT) on augmenting cost effectiveness, improving patient outcomes, and enhancing the collection of evidence-based data to improve healthcare quality for the community. 

Care Coordination and Cost-Effectiveness

Health Information Technology (HIT) is vital in enhancing care coordination. Effective implementation of HIT can lead to coordinated sharing of patient information, leading to safe and effective patient care. Effective patient care may result in significant cost savings within the healthcare system. The underlying assumptions of this analysis include the belief that care coordination is essential to improve patient outcomes, streamline transitions, and elevate the use of resources to reduce complications, prevent unnecessary healthcare expenses, and enhance overall cost-effectiveness. Prevention of hospital readmissions, optimized resource utilization, and effective management of chronic diseases are some of the mechanisms that result in cost-effectiveness due to coordinated care.

Healthcare providers collaborating and ensuring a smooth transition of care from the hospital to other settings, such as home or rehabilitation facilities, prevent unnecessary hospital readmissions, ultimately contributing to cost-effectiveness for the organization. According to the literature, preventing single readmission of patients with Medicare results in financial gains of $10,000 – $58,000 as per the Hospital Readmission Reduction Program  (HRRP). Moreover, preventing hospital readmission rates helps an organization save $170 million annually (Yakusheva & Hoffman, 2020). 

NURS FPX 6612 Assessment 4 Cost Savings Analysis

Furthermore, care coordination enhances resource utilization efficiency within the healthcare system. Through the effective sharing of information using HIT, healthcare providers can make informed decisions about allocating resources for medical tests, imaging studies, and specialist consultations. This results in value-based delivery of healthcare services, avoiding unnecessary duplication of tests and amenities, and leads to cost savings for the organization and patients (Williams et al., 2019).

Lastly, chronic diseases often require ongoing and coordinated care. 85% of healthcare costs are invested in the management of chronic diseases. Thus, coordinated care is essential to prevent disease exacerbations, complications, and recurrent hospitalizations, which are the primary reasons for these elevated costs (Holman, 2020). This proactive approach improves the health and well-being of individuals with chronic diseases, resulting in patient cost savings. Overall, care coordination plays a vital role in balancing quality care and cost savings within the healthcare system.

Care Coordination and Positive Health Outcomes

Health consumerism is the active participation of patients in their healthcare journey. Patient engagement is one of the crucial components of care coordination. Care coordination using HIT tools such as Electronic Health Records (EHRs) and patient portals allows patients to access their health information, empowering them to make healthcare decisions and manage their health effectively. The concept of patient-centeredness elaborates on the cause-and-effect relationship between care coordination and health consumerism.

Coordinated care between provider and patients through regular communication, ongoing monitoring, and tailoring patient care plans according to their needs and preferences encourages them to be informed consumers, actively participating in discussions about their treatment options, medications, and lifestyle choices with healthcare providers (Albertson et al., 2022). By informing patients about their healthcare journeys and fostering a collaborative relationship between healthcare providers and patients, care coordination supports shared decision-making, promoting improved health consumerism. 

Coordinated care through HIT aids preventive care and early intervention, leading to positive health outcomes. With access to personalized health data, individuals are better positioned to adopt preventive measures and make lifestyle changes that positively impact their well-being (Choi & Powers, 2023). Moreover, collaboration among healthcare providers, facilitated by HIT, provides a holistic understanding of patients’ healthcare needs, enabling timely interventions and reducing the chances of complications. Furthermore, HIT-driven care coordination leads to continuity of care, ensuring a smooth healthcare experience for patients across different settings. This continuity of care augments patient experience, resulting in positive health outcomes and promoting a more holistic and coordinated approach to healthcare practices (Cha, 2023).

Care Coordination and Enhanced Evidence-based Data

Patient-Centered Medical Homes (PCMH) is an emerging healthcare model focusing on holistic, coordinated, patient-centered care. It involves a collaborative approach to improve patient outcomes through enhanced communication, patient engagement, and continuous quality improvement (De Marchis et al., 2019). Care coordination can enhance the collection of evidence-based data and quality of care using the PCMH model in several ways. 

• Care coordination through PCMH involves the integration of EHRs to optimize healthcare processes and improve quality. This EHR integration improves the data collection by providing a holistic view of the patient’s health. Moreover, a coordinated and evidence-based data collection approach enables healthcare providers to make evidence-based decisions and tailor care plans to individual needs, improving the quality of care (Jubril, 2019). 
• The PCMH model emphasizes effective communication and collaboration among healthcare providers. This improved communication ensures immediate sharing of relevant patient health information, facilitating the collection of timely and accurate evidence-based data, ultimately encouraging evidence-based decisions, well-coordinated care, and improved healthcare quality. 

NURS FPX 6612 Assessment 4 Cost Savings Analysis

• Practice changes, performance measures, and benchmarking under the umbrella of PCMH aids in assessing and comparing the quality of care provided. This involves systematic data collection to measure performance against established standards. This evidence-based data collected through care coordination helps the organization to identify areas for improvement and healthcare practices with evidence-based standards to enhance the quality of care (Quigley et al., 2021). 
• Care coordination enhances the collection of evidence-based data for analytics and modeling, supported by the PCMH model, to identify disease patterns, predict health risks among the population, and tailor health interventions. This data-driven approach promotes evidence-based decision-making to improve care quality and patient outcomes. 
• The PCMH model continuously monitors patient outcomes and seeks feedback to improve care processes. Care coordination through HIT includes regular data collection on patient outcomes and satisfaction, which helps assess the effectiveness of interventions, upgrade care plans, and guarantee that care delivery aligns with evidence-based best practices. 

Cost Savings Data and Information

The spreadsheet below illustrates the cost savings data after the implementation of care coordination efforts using HIT for one year at Miami Valley Hospital: 

Cost-Saving Element	Current Costs ($)	Anticipated Savings ($)
Reduced Readmission Rates	$2,500,000	$500,000
Streamlined Care Transitions	$750,000	$300,000
Efficient Resource Utilization	$800,000	$200,000
Enhanced Chronic Disease Management	$1,800,000	$600,000
Prevention of Adverse Events	$1,000,000	$300,000
Decreased Emergency Room Utilization	$1,200,000	$500,000
Total Anticipated Savings	–	$2,400,000

 

In the context of Miami Valley Hospital, implementing care coordination using HIT is anticipated to yield significant cost savings across various elements. These include a substantial reduction in hospital readmissions, streamlined care transition process, optimized resource utilization, improved management of chronic diseases, prevention of adverse occurrences, and decreased emergency room utilization. Through the cumulative savings of $2,400,000, the cost-savings analysis underscores the potential economic benefits of leveraging HIT for care coordination, illustrating improved efficiency and reduced costs across multiple aspects of healthcare delivery.

References

Albertson, E. M., Chuang, E., O’Masta, B., Miake-Lye, I., Haley, L. A., & Pourat, N. (2022). Systematic review of care coordination interventions linking health and social services for high-utilizing patient populations. Population Health Management, 25(1), 73–85. https://doi.org/10.1089/pop.2021.0057 

Cha, D. (2023). Digital healthcare: The new frontier of holistic and efficient care. Clinical and Experimental Emergency Medicine, 10(2), 235–237. https://doi.org/10.15441/ceem.23.054 

Choi, S., & Powers, T. (2023). Engaging and informing patients: Health information technology use in community health centers. International Journal of Medical Informatics, 177, 105158. https://doi.org/10.1016/j.ijmedinf.2023.105158 

CMS. (n.d.). Care coordination. https://www.cms.gov/priorities/innovation/key-concepts/care-coordination 

NURS FPX 6612 Assessment 4 Cost Savings Analysis

De Marchis, E. H., Doekhie, K., Willard-Grace, R., & Olayiwola, J. N. (2019). The impact of the patient-centered medical home on health care disparities: Exploring stakeholder perspectives on current standards and future directions. Population Health Management, 22(2), 99–107. https://doi.org/10.1089/pop.2018.0055 

Holman, H. R. (2020). The relation of the chronic disease epidemic to the health care crisis. ACR Open Rheumatology, 2(3), 167–173. https://doi.org/10.1002/acr2.11114

Jubril, A. (2019). Optimizing clinical processes using the electronic health record to improve patient outcomes in primary care. Grand Valley State University 

https://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1102&context=kcon_doctoralprojects 

Quigley, D. D., Slaughter, M., Qureshi, N., Elliott, M. N., & Hays, R. D. (2021). Practices and changes associated with patient-centered medical home transformation. The American Journal of Managed Care, 27(9), 386. https://doi.org/10.37765/ajmc.2021.88740

Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: A qualitative study of primary care provider, administrator, and insurer perspectives. BMC Health Services Research, 19, 92. https://doi.org/10.1186/s12913-019-3916-5 

NURS FPX 6612 Assessment 4 Cost Savings Analysis

Yakusheva, O., & Hoffman, G. J. (2020). Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare’s hospital readmissions reduction program. Medical Care Research and Review, 77(4), 334–344. https://doi.org/10.1177/1077558718795745