2015 Continuity and Coordination of Care Report Results
Continuity and coordination of care is important to the care of the member. Therefore, it is important that the Primary Care Physician (PCP) be kept informed of the member's condition and any treatment provided by special care providers (SCPs), ancillaries, or other health care providers.
Blue Cross Blue Shield Texas (BCBSTX) monitors the continuity and coordination of care between PCPs and servicing providers across the health care network, at least annually. From 2014 Physician Office Review evaluations, opportunities were identified to improve communication between PCPs and specialist consultations. The BCBSTX 2015 Provider Satisfaction Survey was modified to include questions related to continuity and coordination of care in order to better analyze strengths and opportunities. Questions were added specific to the following areas:
- Referral to an ophthalmologist or optometrist for patients requiring a diabetic eye exam and receiving results
- Timely discharge summary data for patients that have been hospitalized is provided to practitioners and includes medication administration instructions
The audits from Physician Office Review Program had high scores related to continuity and coordination of care. One consideration from the evaluation is that offices were randomly selected without knowledge of patients that required continuity and coordination services from other providers. This resulted in very small denominator of records to assess for continuity and coordination of care. Recommendation for future studies, the methodology be evaluated in order to generate a sample of members in need of continuity and coordination of care.
In the 2015 Provider Satisfaction Survey the following items scored less than the target of 85%: receiving eye exam results from eye care professionals, receiving summary information after inpatient discharge and overall satisfaction with continuity of care.
|Survey Question||Goal||BCBSTX 2015 Score|
|33. Do ophthalmologists and optometrists inform you of their findings after seeing patients you referred for diabetes eye exams?||85%||77%|
|34. When your patients are admitted to a hospital, are you sent summary information after the discharge?||72%|
|35. When you receive hospital discharge information, does it reach your office within five business days?||80%|
|36. When you receive hospital discharge information, does it contain adequate information about medications at discharge?||88%|
|40. Overall Satisfaction with Continuity of Care||76%|
The findings of this survey recognize the barriers to care that impact Continuity of Care Coordination and BCBSTX's HEDIS rates. The possibilities for improvements were identified to remove barriers impacting continuity and coordination of care.
To support continuity and coordination of care, BCBSTX is recommending the following interventions. Specialists should provide a report to the Primary Care Physician summarizing the member's visit, the services provided, and recommended follow up treatment or needs. Additionally, BCBSTX recommends hospitals provide timely discharge summary reports to primary care physicians which includes a synopsis of the stay, treatment or procedures done, follow up needs, and a list of discharge medications Please contact Quality Improvement Programs at 1-800-863-9798 with questions or comments.