Care Coordination and Care Collaboration: Improving Clinical and Financial Outcomes

Successfully aligning physician performance with the Triple Aim goals of reducing per capita healthcare costs, increasing care quality and improving population health involves both care coordination and care collaboration. It requires tools that enable clinicians to not only know the status of a patient’s care and what has been done to date, but also share information with all care teams throughout the entire patient journey. This ensures that providers do not duplicate or miss services.

The benefits of true care collaboration include:

  • Reduced costs
  • Greater operational efficiency
  • Better patient hand-offs
  • Smoother transitions of care
  • Improved patient safety and outcomes

EHRs fall short in supporting care coordination and collaboration

There is no question that EHRs perform certain functions extremely well and are the backbone of the healthcare digital world. However, there are many functions they weren’t designed to manage.

missing EHR piece of care coordinationEHRs don’t extend seamlessly to other systems, so they don’t readily support value-based care throughout the care continuum. EHRs lack proper tools to facilitate care coordination and care collaboration, particularly with SNFs and other post-acute providers. These settings often have more primitive EHRs than hospitals, as they have not benefited from the same monetary incentives to adopt electronic records. What should be a continuous process of sharing data and expertise between inpatient and outpatient or post-acute care facilities is often missing.

Additional tools must integrate into the patient encounter workflow and enable physicians and care team members to share secure messages and care team notes across the entire enterprise.

Between more value-based care models emphasizing bundled payments that include a post-acute component and readmission penalties (which continue to plague a surprisingly high number of hospitals), improved care coordination and collaboration are essential.

This capability has become especially critical with COVID-19 because hospitals must discharge frail patients to post-acute providers in a way that does not risk infection or increase costs unnecessarily.

Enhanced care team collaboration

Ingenious Med facilitates provider collaboration regardless of location, service or device, ensuring continuity of care with HIPAA-secure notes and messaging. Our tools connect administrators and back-office staff directly to front-line providers and enable virtual huddles across care teams to quickly share patient information, disposition logistics and more.

mobile care coordination at hospitalIngenious Med’s platform is nimble and can adapt to a rapidly changing healthcare environment during the pandemic. As a response to COVID-19, we created new flags that enable customers to flag both patients with known COVID-19 infection and persons under investigation (PUI). Learn how Scripps Health used this functionality to improve care coordination and collaboration to deploy staff efficiently, avoid having high-risk staff treat COVID-19 patients and reduce PPE usage.

Key Ingenious Med care coordination capabilities include:

  • Multi-disciplinary/virtual rounding. Improve outcomes and patient safety by boosting team communication through care team notes, which ensure higher-quality handoffs.
  • Customizable patient flags. Prioritize patients by risk or proximity to discharge date, resulting in lower costs and fewer discharge delays.
  • Real-time, HIPAA-compliant, secure Expedite care and improve multi-disciplinary workflows by sharing patient-centric information in real time, across the entire health system, within a mobile application.
  • Estimated length of stay. Continuously monitor discharge dates and length of stays to help reduce avoidable bed days and identify trends in efficiencies.
  • Direct PCP notifications. Send secure faxes for admission or discharge automatically from Ingenious Med to the patient’s primary care provider – with no printing required.
  • Narrow network disposition search. Identify and track preferred sub-acute care facilities to streamline the facility search process.

To learn more about opportunities for increasing care coordination and collaboration, improving your performance and productivity, and optimizing your revenue cycle, contact an Ingenious Med representative at 770.799.0909 or visit