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The key to medical neighborhood success? Care compacts.

February 16, 2017

    The patient-centered medical home can go only so far in providing comprehensive, coordinated care. To extend the positive elements of the medical home beyond primary care, you need medical neighborhoods—but there are significant communication barriers between PCPs and specialists that must be overcome for the neighborhood model to work.

    Fortunately, care compacts provide the mechanism for addressing challenges such as poor feedback loops or collaborative care planning.

    What is a care compact?

    A care compact is a formalized agreement between PCPs and specialists that designates referral protocols, care transition expectations, and care management responsibilities. (They are also referred to as service agreements, transition of care records, and care coordination agreements).

    Although care compacts are not legally binding, the documents help formalize communication pathways, appropriate and timely consultations and referrals, and efficient flow of patient care information to support patient-centered, high-quality care.

    Which specialties most commonly implement care compacts?

    A recent CMS study of Comprehensive Primary Care (CPC) initiative practices indicates that care compacts are most common between PCPs and gastroenterologists and cardiologists, though they are used widely across specialty service lines. Anecdotally, they also appear to be popular between PCPs and oncologists.

    What are the benefits of a care compact?

    Developing a care compact enhances both patient and provider satisfaction.

    Patients experience more coordinated care that better adheres to their needs and preferences regardless of site of care or provider. Patients are also more likely to avoid unnecessary or duplicative testing.

    Meanwhile, providers are able to more easily collaborate and share information. Care compacts also facilitate improved efficiency and the development of tighter networks of trusted, high-quality partners with similar values.

    What are the four steps involved in developing an effective care compact?

    1. Identify communication gaps: Align objectives by identifying current challenges to collaboration and how you expect a care compact to address those challenges.

    2. Articulate measurable care compact goals: Enhance provider accountability by establishing clear short- and long-term goals for compact implementation.

    3. Educate and train staff: Foster commitment by training all staff on the goals of compacts (e.g. clearer documentation standards, more efficient task distribution), the specifics of the agreement, and their responsibilities.

    4. Audit changes: Regularly assess progress to compact adherence, pinpoint improvement opportunities, and refine existing metrics.

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