Care Continuation

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals

Care coordination refers to the system of directing and monitoring a member's care among multiple health care providers, encounters and procedures so that the member receives timely, medically necessary health services without interruption.

The system comprises several procedural components that are required based on the extent of the severity of the member's health condition. Basic procedures required of primary care physicians (PCPs) to maintain care coordination are:

  • Documentation of member encounters, missed appointments, extensions of appointment waiting time (noted that a longer waiting time for appointment will not have a detrimental impact on the health of the member), and referrals in members' medical record
  • Referral of members needing specialty health services
  • Forwarding summaries of pertinent medical findings to specialists
  • Documentation of services provided by a specialist in the member's primary care medical record
  • Monitoring members who have ongoing medical conditions
  • Notifying Health Net of member referrals to specialists, care management or public health programs

Additional procedures are required of PCPs when members' health conditions require urgent, emergency or inpatient health services, including:

  • Documentation in members' medical records of emergency and urgent medical care and follow-up
  • Coordinated hospital discharge planning
  • Post-discharge care

Health Net suggests that each provider develop protocols to maintain care coordination. A log system for tracking prior authorizations, referrals to specialists, follow-up of missed appointments, and acknowledgment and verification of such things as lab and X-ray findings is recommended. The system can be manual or computerized.