Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

October 2016

2015 Continuity and Coordination of Care Report Results, and Recommended Interventions

Continuity and coordination of care is important to the care of members. Therefore, it is important that the Primary Care Physician (PCP) be kept informed of a member’s condition and any treatment provided by specialist providers (SCP), ancillaries or other health care providers.

Blue Cross and Blue Shield Texas (BCBSTX) monitors the continuity and coordination of care between PCP and specialist providers across the health care network, at least annually. From 2014 Physician Office Review evaluations, opportunities were identified to improve communication between PCP and specialist consultations. The BCBSTX 2015 Provider Satisfaction Survey was modified to include questions related to continuity and coordination of care in order to better analyze strengths and opportunities.

Specific questions were added to the following areas:

  • Referral to an ophthalmologist or optometrist for patients requiring a diabetic eye exam and receiving results
  • Timely discharge summary data for patients who have been hospitalized is provided to practitioners and includes medication administration instructions

The audits from the Physician Office Review Program had high scores related to continuity and coordination of care. One consideration from the evaluation is that offices were randomly selected without knowledge of patients that required continuity and coordination services from other providers. This resulted in very small denominator of records to assess for continuity and coordination of care. Recommendation for future studies is that the methodology should be evaluated in order to generate a sample of members in need of continuity and coordination of care.

In the 2015 Provider Satisfaction Survey the following items scored less than the target of 85 percent:

  • Receiving eye exam results from eye care professionals
  • Receiving summary information after inpatient discharge
  • Overall satisfaction with continuity of care
Survey Question Goal BCBSTX 2015 Score
33. Do ophthalmologists and optometrists inform you of their findings after seeing patients you referred for diabetes eye exams? 85% 77%
34. When your patients are admitted to a hospital, are you sent summary information after the discharge? 72%
35. When you receive hospital discharge information, does it reach your office within five business days? 80%
36. When you receive hospital discharge information, does it contain adequate information about medications at discharge? 88%
40. Overall Satisfaction with Continuity of Care 76%

The findings of this survey recognize the barriers to care that impact continuity-of-care coordination and BCBSTX’s HEDIS rates. The possibilities for improvements were identified to remove barriers impacting continuity and coordination of care.

To support continuity and coordination of care, BCBSTX is recommending the following interventions:

  1. Specialists should provide a report to the Primary Care Physician summarizing the member’s visit, the services provided and recommended follow-up treatment or needs.
  2. Hospitals provide timely discharge summary reports to primary care physicians that include a synopsis of the stay, treatment or procedures done, follow-up needs and a list of discharge medications.

Please contact Quality Improvement Programs at 800-863-9798 with questions or comments.