Does clinical coordination improve quality and save money?

This report examines the evidence for the extent to which poor coordination contributes to poor quality outcomes for patients and the approaches to clinical coordination which are shown to improve care and whether these can reduce costs.

Background

As healthcare and payments become more fragmented, and resources become fewer, there is a greater emphasis on improving the value of healthcare services through reducing costs while maintaining or improving quality.

Providers may focus more on their part of the care pathway and less on passing on information and adjusting their work around the total care of the patient. Without coordination, adverse events and poor quality can increase, adding costs and then leading to bureaucracy to enforce procedures which do not solve the problems of under-coordination.

Evidence that clinical coordination improves quality and saves costs

The review concludes that greater coordination of care has the potential to reduce costs and should be a major consideration for how to improve quality and save money in the current funding situation. However, while better process coordination could release significant savings, these approaches also have high risks and costs.

Improving coordination is about relationships between people, which is why it is difficult. One of the most important messages from this review is that there are models of care which improve clinical coordination and have been shown to reduce cost but that attempts to replicate these need very careful consideration. By its nature, coordination is dependent upon the local context, so the opportunities and costs will vary in each different healthcare system and in different settings within the system.

The review summarises and grades the strength of the evidence, so that it is clear which approaches are the most robustly evaluated. Some of the evidence is not conclusive, as many changes that aim to improve coordination have not been well evaluated.

The final section of the report suggests how patients, health service providers, commissioners, regulators and professional organisations could all take some responsibility for improving clinical coordination and thus reducing duplication, waste and thus the overall costs of healthcare. 

What is the Health Foundation doing?

The Health Foundation is supporting research into value for money in healthcare, which is building the evidence base to inform how changes in health service delivery can be made to help address the challenge of continuing to improve quality for patients in a demanding financial climate.

This includes research projects working on macro level health economics analysis, examination of the comparative value of components of care pathways and the extent to which patient collaboration can increase value for money in healthcare services.

Who should read this report?

This report will be of interest to commissioners of health services and to any providers of health services who need to manage care transitions and collaboration with other service providers to ensure high quality care throughout the patient journey. The findings highlight the issues to consider in planning changes in service design to improve clinical coordination.