Care coordination is the heart of what helps keep patients healthy and out of the hospital.
Care coordination in the primary care practice involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. The coordination involves communication among everyone involved with the patient, including hospitals, doctors, nurses, pharmacies, physical therapists, and the patient.
More than 180 care managers (nurses and social workers) are working in CHI Health Partners -affiliated acute and ambulatory settings across Nebraska and southwest Iowa. These care managers may also be called population health coaches or care coordinators. They help chronically ill patients navigate complicated issues like diabetes and high blood pressure, and help improve patients' overall health. Population health coaches are part of value-based care, a proven strategy to lower total health care costs by providing the right kind of care at the right time.