Ethical and Policy Factors In Care Coordination

Ethical and Policy Factors In Care Coordination
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Ethical and Policy Factors In Care Coordination
Callen-Lorde Community Health Center is a community primary health care center located in New York. The organization is a leader and advocate of providing sensitive, comprehensive, quality, and culturally sensitive mental health services to members of the LGBTQ population, irrespective of their ability to pay. Other healthcare services provided to marginalized LGBTQ youth and adults include medical case management support, women's health services, and dental care. The community organization serves underserved members of the service area, and coordination of care is often compounded for those experiencing homelessness. It is therefore critical for the healthcare center to understand ethical and policy issues that affect the coordination of care.
Government policies related to the health and/or safety of the community have a great impact on the coordination of care. A majority of these policies are geared to enhance communication as well as the quality of care transitions across health care settings by increasing both accountability and integration of health care systems together with communities to improve quality of care and decrease health disparities. For instance, the Affordable Care Act (ACA) insisted on new models of health care delivery and payment that stressed the higher quality of care at reduced costs through care coordination (AHRQ, 2016). By holding care organizations accountable for the quality of care and care expenses, ACA forced community organizations to improve care coordination. Community organizations are now required to integrate their services across the health care delivery system with the common objective of reducing medical errors and preventing duplication of health care services. The ACA requires these centers to coordinate patient discharge to other care settings and reduce hospital readmissions.
Another example of how government policy related to the health and/or safety of the community influences coordination of care is that of chronic care management (CCM), which was instituted in 2015 by the Centers for Medicare and Medicaid Services (CMS). The CCM is a distinct paid service categorized under Medicare Part B benefit that offers compensation for providers who provide care to patients outside the usual boundaries of the typical office visit. CCM is intended to improve care coordination among care teams when treating and managing patients with chronic ailments, thereby reducing treatment expenses, over and above, improving health care outcomes. The CMS recognizes that CCM is a central element of primary care that improves care coordination for Medicare patients with two or more problematic chronic conditions and at risk of functional decline, considerable risk of death, and acute exacerbation (CMS, 2021). Some of the CCM activities include liaising with the patient’s other physicians to exchange health information, communicating with patients by secure email or telephone to appraise test results and medical records, management of care transitions, and coordinating home- as well as community-based care services.
CCM services are provided at any time of the day by an assorted team of health care professionals and clinical staff at Federally Qualified Health Centers (FQHCs), Critical Access Hospitals (CAHs), and Rural Health Clinics (RHCs). Providers only receive payment for facilitating care coordination, enhancing practice efficiency, and improving patient satisfaction and compliance to a treatment plan. As a result, patients receive care from a coordinated team of clinicians, who work together to develop a holistic care plan aimed at managing their diverse chronic conditions. Both ACA and CCM encourage the flow of information between clinicians during care coordination through the meaningful use of interoperable electronic health records (EHRs) across the health care delivery system. Most providers have moved away from paper records and towards interoperable EHRs to facilitate the convenient and rapid sharing of patient information in real-time during care coordination. However, this sharing of information is fraught with data security risks: data can be hacked, destroyed, or manipulated by external or internal actors, and therefore security measures are necessary to ensure patient data integrity. To this end, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was instituted in 1996 to protect sensitive patient health data from breaches or disclosure without the patient’s consent or knowledge.
The Administrative Simplification provisions of ACA expanded on HIPAA and require healthcare institutions to implement national standards for electronic health care transactions and code sets, securi...