Overview

Nurses, Therapists, Medical Social Workers, Home Health Aides, and Personal Care Workers provide long-term or short-term care for patients based on their needs.

Millions of patients receive home care every year. Providing quality patient care is critical for home care agencies for patient satisfaction and growth while complying with regulatory requirements. Improving the quality and effectiveness of patient care is a collaborative effort of the entire organization - requiring both caregivers and administrative personnel to collaborate.

Care Coordination plays a critical role in improving collaboration, quality of care, and compliance. Home Health Care Agencies need the tools to coordinate care effectively and efficiently to ensure the highest quality and level of service.

Importance of care coordination in home healthcare

What is Care Coordination?

Care Coordination is the deliberate organization of patient care activities among all participants (including the patient and patient's family) involved in a patient's care to facilitate the appropriate delivery of home health care services. Organizing care involves marshaling personnel and other resources needed to carry out all required patient care activities. It is often more effective when information is exchanged effectively among participants responsible for different aspects of care.

The perspective of care coordination might vary based on the participant involved in a patient's care.

Patient/Family Perspective

Patients, their families, and other caregivers experience failures in care coordination, particularly at transition points. For patients receiving home health care services, transition usually occurs between shifts or when the patient goes to a hospital or a physician for additional care. Effective care coordination will significantly reduce the effort required for the patient, patient's family, or caregivers to continue delivering care for the patient.

Home Care Clinicians' Perspective

Clinicians or health care professionals notice failures in care coordination when they do not have access to all the information necessary to continue patient care leading to poor quality of care and poor health outcomes. Effective care coordination will significantly reduce the levels of effort required by the clinicians to continue providing quality care for the patient.

Administration Perspective

Administrators notice failure in care coordination at the points of timely authorization, effective use of limited clinical resources, increased cost, and decline in patient satisfaction. Effective care coordination will improve operational efficiency by minimizing non-billable time, reducing care costs, and improving patient and employee satisfaction.

Home Health Care Agencies should develop effective processes and select the right tools for care coordination to improve the quality of care and patient satisfaction.

Care Coordination Tools for Home Health Care Agencies

Care coordination can take many forms for Home Health Care Agencies. These care coordination activities include communicating the late arrival of the caregiver, exchanging relevant information between shifts, providing information to patients or families for continuing care, communicating medication and treatment changes in real-time, etc. Communication among participants in delivering and managing care for a patient is the most critical component of care coordination.

Home Health Care Agencies should develop processes and use a software platform that provides multiple care coordination tools that are easy to use to improve quality of care, patient satisfaction, operational efficiency, and compliance. Home Health Care Agencies should take a holistic view of the care coordination needs of the agency before settling on the processes and the technology platform.

The following are some care coordination tools to help home care agencies develop an effective care coordination process.

eFax and Direct Messages

Sending a plan of care and change orders and receiving signed documents back is one of the challenges home care agencies face in their day-to-day operations. Integrated eFax functions to send and receive the plan of care, change orders, and clinical notes will significantly improve the efficiency of this process and improve compliance and timely billing of claims.

Direct Messages will enable home care agencies to communicate with physicians, healthcare professionals, and organizations by sending and receiving discharge summaries, clinical summaries, and clinical notes with other healthcare professionals.

eFax and Direct Messages will significantly improve Care Coordination activities for home health care agencies.

Secure Messaging

An integrated, HIPAA Compliant, and internal messaging application is essential to improve care coordination within the agency that is effective. The messages are only for users, employees, patients, and families with an internal application. This communication tool will help agencies securely communicate with all participants of patient care.

Communication Logs

During an episode of care, it is normal to have conversations with patients, employees, the care team, and external healthcare professionals regarding patient care, scheduling preferences, and billing options. It will be essential to record some of these conversations and attach them to patients and employees. These communication logs will help improve care coordination activities for a patient.

Some of these conversations may have confidential information. A software platform should create a log and provide a unified view of all communications in one place. It should also include an option to limit access to these logs based on employees' roles.

Schedule Reminders

Options to send schedule reminders to patients and employees the day before the visit or shift will reduce the potential for missed visits or shifts. Schedule reminders are essential for Private Duty Nursing and Non-Medical Home Care Agencies with high volumes of patients and shifts. Reducing missing visits and rescheduling missed visits are critical components of care coordination activities.

Patient Care Changes

During patient care, care plans can change based on how the treatment works. Clinicians may prescribe new medications or modify/discontinue the current medications. When the patient's condition improves or changes, Clinicians can and will make appropriate changes to the care plan and treatments. These care plan changes should reflect at the point of care in real-time.

Communicating treatment changes to the point of care in real-time is a very critical care coordination activity. Real-time communication improves patient safety, health outcome, and satisfaction.

Holistic View of the patient

The clinicians need to have a holistic view of the patient at the point of care. They should be able to access patient information, schedules, medications, care plan, and past clinical notes without navigating through multiple screens. This information should be available before starting the visit/shift or during the visit/shift. Having access to all clinical information of a patient will help a clinician provide quality care and improve care coordination. A software platform should provide easy access to patient clinical information.

Portals

Integrated Family and Employee Portals will be beneficial in communicating with the patient, patient's family, and employees. These portals will provide access to schedules and other information for patients, families, and employees. Portals for families, employees, and patients can help communicate Care Coordination activities. Home Care Agencies must choose a software platform with integrated portal options, not third-party options.

Schedule Monitor

The ability to monitor schedules in real-time will be essential to make sure visits/shifts start on time, all the assigned tasks are completed and end on time. This function will benefit Private Duty Nursing and Non-Medical agencies with a high volume of visits/shifts. Monitoring shifts/visits in real-time will significantly improve care coordination for a patient.

Conclusion

A software platform should provide the necessary care coordination tools to improve quality of care, patient satisfaction, compliance, and employee satisfaction.

CareVoyant for Home Care is an integrated, cloud-based software platform with easy-to-use care coordination tools for Home Health Care Agencies offering multiple services – Private Duty Nursing, Non-Medical, Personal Care, HCBS, Pediatric Home Care, and Home Health - under ONE Patient and ONE Employee making it a Single System of Record. CareVoyant provides the tools to effectively coordinate care delivery for home care patients.

About CareVoyant:

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.