Tag: care coordination
Articles
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What It Feels Like to Have a Care Team Between Visits
A doctor’s appointment can give you answers, a treatment plan, and a clearer idea of what needs to happen next. But once you leave…
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Remote Monitoring Works When Someone Is Accountable for the Alert
The device is the easy part. The hard part is the named human who sees an out-of-range reading on a Friday afternoon.
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Social Risk Data Is Only Useful If Something Happens Next
Screening for food insecurity without a referral pathway is a way of documenting a problem you have decided not to solve.
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Panel Size Is the Wrong Lever
Two clinicians with identical panel sizes can have entirely different workloads. Complexity, not headcount, should drive staffing.
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Medication Reconciliation Fails at the Handoff, Not the Interview
The list is usually accurate when it is taken. It degrades in the gap between settings, and that gap is where the harm occurs.
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Chronic Care Management Billing Is Not the Point, But It Pays for the Point
Programmes built purely around the billing code tend to collapse. Programmes that ignore it tend to be defunded.
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Telehealth Found Its Floor, and That Is Good News
Utilisation settled far below the 2020 peak and far above the 2019 baseline. The settled level is where the clinical value actually is.
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What We Got Wrong Building Our First Care Gap Dashboard
It was accurate, comprehensive, fast, and almost nobody used it. Here is what we learned from the rebuild.
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Closing the Loop on Referrals Without Buying Another Platform
Referral leakage is usually described as a technology gap. More often it is an unowned step in an otherwise functioning process.
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