New Medical Staffing Roles Emerge due to Healthcare Reform

March 27, 2013

More practices are adding care coordinators and/or patient navigators to their teams. Here’s what these individuals do and why they are becoming so popular.

As the shift from traditional fee-for-service to value-based reimbursement gains momentum, many practices are adding patient navigators and care coordinators to their teams. In fact, one out of every five respondents to our 2013 Staff Salary Survey said they employ a care coordinator whose sole job is to coordinate patient care and/or offer referrals to other healthcare providers.

But while care coordinators (often known by a number of different names including patient navigators) are gaining traction at practices, these roles are still quite new, and confusion remains about who these individuals are and what they do. To clear up the confusion, here’s a quick look at the what, who, and why of care coordination.

What is a care coordinator:  The role of care coordinator is difficult to define because it often differs practice to practice. Still, care coordinators tend to share some common responsibilities, such as helping patients navigate the healthcare continuum, increasing patient outreach and monitoring (especially of high-risk patients and/or those with chronic conditions), and helping manage transitions of care.

“Having a care coordinator on-site doing outreach to the patient increases primary-care utilization, which allows us to have better understanding and control of blood work outcomes, medication management, and specialist referrals,” Janet Duni, a nurse who is the director of care coordination at Vanguard Medical Group in Verona, N.J., told Physicians Practice. “Those three things really influence the level to which a patient is engaged, and how their disease process is monitored, and the outcomes of their disease processes.”

Who is a care coordinator: Because the role of a care coordinator is so patient-centered, many practices employ care coordinators who are also registered nurses. Sometimes practices will ask their current nurses to take on care coordination responsibilities; others will hire nurses whose sole purpose is to serve as care coordinator.

The latter is the best course, said Duni.  “The care coordination function is not an add-on, an extra thing that you do once in a while or a few times a week, it’s a consistent and fairly complex role that needs to have its own space within the work flow of the practice.”

Why care coordinator are gaining traction: Care coordinators tend to be found most often in primary-care practices that are transitioning to medical homes, or that are already medical homes, Atlanta-based consultant Elizabeth Woodcock, founder of practice management company Woodcock & Associates, told Physicians Practice. “It’s a really core role, and I truly mean a core role, for the Patient-Centered Medical Home.”

Some payers are even providing Patient-Centered Medical Homes (or practices transitioning to the new model of care) with embedded care coordinators. Duni, for instance, got her start as a full-fledged care coordinator as an employee of Horizon Healthcare Innovations, a division of Horizon Blue Cross Blue Shield of New Jersey, when it hired her and placed her in a primary-care practice.

“One of the reasons they decided to put care coordinators in the community was because they were seeing that ... in other states using the Patient-Centered Medical Home as the primary-care model - in which care coordination was a central piece - they were seeing that patients were responding better, there was higher engagement, that the same job that their in-house care coordinators were trying to do was getting done more efficiently when the coordinator was in the family practice representing the physician in a closer relationship,” said Duni.

Is your practice planning to hire a care coordinator in 2013? Share your thoughts and plans in the comments section below.

The full findings from our 2013 Staff Salary Survey will be released in May, 2013. Last year’s survey findings are available here.