Response by author Jean Scholz Mellum to Lisa Palucci on “Registered Nurse Care Coordination: Creating a Preferred Future for Older Adults with Multimorbidity” (September 30, 2015)Patient-centered care does not occur without the identification of the specific needs of individuals. When patient-centered care does occur, it will likely lead to increased engagement in care and increased self-management of chronic illnesses (Mellum, Martsolf, Glazer, Tobias, & Martsolf, in press). Furthermore, without the partnership between provider and patient which generally occurs with patient-centered care, effectiveness and efficiency is lost and Triple Aim outcomes may not be met. Assessment of individual specific needs related to cognitive status, functional status, and psychosocial resources/needs will most likely decrease health disparities and inequities across a population. This type of individualized care is theorized to be care that is efficient and cost-effective over time and across all settings.
Models of care coordination that serve individuals specific needs will probably work in a variety of populations and in urban as well as rural settings. Yet it may be challenging to achieve economies of scale in areas with small numbers of older adults with multimorbidity. The infrastructure costs of developing and operating a CCP may exceed the capital or financial resources of an area. In those situations, it is important for nursing leadership to identify partners for collaboration. In some locales, these types of collaborations have led to Accountable Care Organizations (ACOs), or partnerships to create value for payers and patients by coordinating care and managing overall costs and health outcomes associated with the care for individuals within that population. Nurse leaders from across the country have started ACOs or have been intimately involved with them. It seems that ACOs with strong nursing input are the most holistic and will have sustainability because they meet the many issues associated with the unique needs of each multimorbid older adult.
Jean Scholz Mellum, Ph.D., RN, NEA-BC
Columbus, OH 43209