Introducing the Care Coordinator


I just found a huge steaming pile of made-up terms in this article called Avoiding the ER: ‘Care coordinators’ see increased role in health care evolution.  Right off the bat, in the title, comes Care Coordinator and Health Care Evolution.  That was my first hint that the bullsh&t was about to fly.  To my delight, the meaningless article did not let me down. I decided to dissect out how many more administralian terms were used in this article:

The workshop was the first in Oregon, though Regence has held them in Washington and Idaho. The purpose is to allow clinical personnel to share best practices to support Total Cost of Care, Accountable Health Networks and the Medicare Quality Incentive Program.

Best practices.  Total Cost of Care.   Accountable Health Networks.  Medicare Quality Incentive Program.  Ahhh, the four horseman of bullsh$t.  Well played.

Care coordination is an essential component of the move away from “fee-for-service” to value-based care, or population health, said Dr. Jim Guyn, executive medical director of Accountable Health and Quality at Cambia Health Solutions, Regence’s parent company.

Value-based care and population health.  My diagnosis?  Verbal diarrhea.

Dr. Prasanna Krishnasamy, medical director for Medical Home at Legacy Medical Group, said this shift is “resource intensive,” as care coordinators are put in place and procedures standardized. It may take several years to see a return on investment in the form of reduced utilization and improved quality metrics.

Resource Intensive, reduced utilization and improved quality metrics.  It’s like he is asking “How can I so little by saying so much?”

“There’s a lot of front-loading,” he said. “It’s important to collaborate with the payers.”
Krishnasamy and other panelists said it’s helpful to give doctor’s incentives in their compensation for hitting quality metrics.

Front loading and collaborate with payers.  Well, this unadulterated crap means nothing to nobody.

Dr. Chad Lowe, who developed Adventist Health’s Resilience Center, said he once went so far as to track down a missing patient in a barn.

No new terms here but tracking a patient down in an barn, huh?  Well, that’s perfect because this type of healthcare is just herding cattle anyway.

“We do what we can to avoid hospitalizations,” he said. “When there’s a need, we do it.”
Krishnasamy said it’s important for doctors to do a “warm handoff” to introduce patients to the care coordinator on the team.

Warm handoff.  Sounds pornographic.

“Patients want to connect with people,” he said.

Really?  Actually, patients just want to connect with their doctors.  Remember them? And this kind of crap is stopping that from happening.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Introducing the Care Coordinator

  1. Anthony Wunsh
    September 29, 2015 at 9:31 pm

    I always ask a few questions regarding VBM. One: How much will it add to the cost of care. Two: How long before we realize actual savings, ten years, twenty years, one generation, two?

    Fee for Service was brought to us by the same policy makers who now say it was bad. Well another question to ask, if the reason we have to move from fee for service is because you blame doctors for gaming the system, what makes you think the same doctors won’t game VBM by treating only the healthiest of the sick in a group. Don’t get me wrong I don’t agree docs are the problem, just that is the narrative for the need for this change.

    And next, if we removed the 400-600 billion a year in defensive medicine due to how tort is handled what would fee for service numbers look like then.

    And by the way we tried it before, it was called HMO and it drove up costs at record rates, and failed to prevent anything.

  2. John Kelly, MD, MPH
    September 29, 2015 at 3:57 pm

    I’m being told by Blue Care Network that we haven’t met goal numbers with patients assigned to us but who haven’t ever been seen. They say this with a straight face, and tell me it’s an opportunity for outreach to the community. A few are many miles across Michigan. We are first told to send three certified mail letters, at least a month apart, before even thinking they might be removed from our list. Later, they say we can call them and keep a record of attempts. We leave messages and they don’t reply. I have a load of patients who “don’t like taking pills,” or “will never get a colonoscopy,” or “don’t eat sugar and ought to be not diabetic.” Do I dump them? BCN will pay for a screening colonoscopy, but if they find a polyp, it was a diagnostic colonoscopy and they don’t pay for those! People are coming in when I force their return or won’t refill their meds. Everybody has higher deductibles. BCN has said that since I didn’t meet goals, I cannot take any more of their patients, and may drop me, as the physicians’ organization has threatened since I don’t make data goals and drag the rest down. I think they want the solo practitioner GONE. Factory Minute Clinics of America! The local Integrated Health Associates gave their docs 8 minutes a patient. Don’t make goal? You’re gone. Who among them really believe they have measured the worth of a doctor with BIG DATA? Are they that arrogant?

  3. Perry
    September 29, 2015 at 8:46 am

    Move from “fee for service” to value-based care- We will design an arbitrary, confusing system by which to pay doctors, disperse the funds to the ACOs and let them decide how to pay, meanwhile of course, doctors will continue to work for peanuts.
    Resource intensive- We will hire many employees for lots of money but can’t guarantee a return on our investment.
    Incentives for hitting quality metrics- You better follow the protocols and guidelines or your pay will be slashed.
    Avoid hospitalizations, we do it when we need to- You’d better be dying, but then again we’ll just send in hospice and let you die at home. Don’t want to muddle up our stats.
    Patients want to connect with people- Well, about that, we’ll have populations connecting with organizations, how about that?

    • Steve O'
      September 29, 2015 at 9:44 am

      OOO Thanks Patty. Patients want to connect with people- Well, about that, we’ll have populations connecting with organizations, how about that? Hmm…we need to reparameterize our infrastructure to end the unpredictable meat-meat interface between people, and dispose of them efficiently by their labels and categories. That’s what the message is.
      Since people can be handled as though they are plastic Chinese factory goods, and the production line is no place for “human variability,” then as care coordinators are put in place and procedures standardized. It may take several years to see a return on investment in the form of reduced utilization and improved quality metrics. When you treat the meat, either the meat responds correctly, or one lets nature take its course. The more often nature takes its course, the less utilization is needed – and if maximizing death is a metric of quality, then the future is unbounded. The sky’s the limit.
      If the oppressors were foreign invaders, this would be genocide. But we are doing it to ourselves. What does that make it? Why do we do it?

      • perry
        September 29, 2015 at 12:14 pm

        Cannibalization is what I would call it. We do it to save the “population” ie, government, money.

        • RSW
          September 29, 2015 at 7:04 pm

          “We do it to save the “population” ie, government, money.”

          I’m willing to put a little effort into saving the government money. But I am very certain that I have absolutely no ethical or moral obligation to save money, i.e. increase profits for United, Aetna, et al. That physicians and their representatives buy into this lie just shows how low our professional standards have sunk.

          • September 29, 2015 at 8:00 pm

            Physicians have sold out to the business interests over and over and over again since the 60s. Apparently the lesson is never learned. I truly don’t get it.

          • Pat
            September 29, 2015 at 11:07 pm

            Why be interested in saving the government money, but not a Big Insurance? They both have bloated administrative cost, both lie constantly to their clients, both coerce doctors into bad behavior, both constantly lie to doctors and patients even as they pit those groups against each other, both restrict the freedom of action of both patients and doctors, and both seek to cheat the doctors out of legitimate earnings even as they increase the doctors’ overhead. Of course one major difference is that the government has guns, can shut you down, and can put you in jail – is that why you would make a little effort for them?

            I cannot understand why all of my colleagues’ valid criticisms of Big Insurance are not leveled as quickly at Medicare and Medicaid, which are Ground Zero for this swindle.

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