Alternative payment models lead to strategic care coordination workforce investments

Care coordination is generally viewed as a key to success for health systems seeking to adapt to a range of new value-based payment policies. This study explores care coordination staffing in four health systems participating in new payment models, including Medicaid payment reform and Accountable Care Organizations. Comparative case study design is used to describe models of care coordination. Analysis of 43 semi-structured interviews with leadership, clinicians, and care coordination staff at four health systems engaged in value-based contracts. Each of the sites engaged in significant task shifting of low-complexity care coordination activities to licensed practical nurses, medical assistants, and other unlicensed personnel freeing up registered nurses and social workers for more complex patients. Few have care coordination experience, requiring a significant investment in on-the-job training. Payment reform is leading to a greater investment in the care coordination workforce. However, demonstrating the return on investment remains a challenge.