Payer Perspective: Care Coordination of Chronic Diseases

Payer Perspective: Care Coordination of Chronic Diseases 

Care coordination is the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of healthcare services. Increasing prevalence of chronic illness among Americans, even as life expectancy grows and the population ages, poses major challenges to the medical profession and the entire healthcare system. Coordination is a multifaceted activity that requires effective participation among different professionals, service organizations, and most importantly the patient. Uncoordinated care can result in duplication of service or lack of necessary services for patients with chronic conditions. Both examples can lead to higher short-term and long-term costs and worse patient outcomes. Conversely, coordination of care can impact provider reimbursement. This course will provide information on the process of care coordination, what is practiced today, and what we can do in the future. We will also review the different components to care coordination and how to apply these components in your workplace.


Hours: 1.00


Certificates provided by accrediting body (1 Match)

Commission for Case Manager Certification


This program has been pre-approved by The Commission for Case Manager Certification to provide 1.00 hours of continuing education credit to CCM® board certified case managers.

Course Details

Course Code: REL-PI-0-P71
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2021
Learning Objectives:
Define and describe the role care coordination can play in managing health and healthcare costs.
Describe what successful care coordination looks like and who is involved.
Describe how uncoordinated care can lead to waste and duplication of services.
Explain how to best follow-up with both providers and members so comprehensive clinical data is shared.
Identify the components and efforts involved in care coordination.
Apply new knowledge of techniques to improve care coordination in your current practice.

Section 1: Introduction A. About This Course B. Learning Objectives Section 2: The Complexity of Care Coordination A. Meet Laura B. Define Care Coordination C. The Components of Care Coordination D. Why is Care Coordination Necessary for Those with Chronic Diseases? E. The Chronic Care Model F. Self-Management G. Case Management H. Different Care Coordination Approaches I. Results of Care Coordination J. Review K. Summary Section 3: Creating a Better Experience with Care Coordination A. Identify Beneficiaries B. Identify Participants C. Developing and Implementing the Plan of Care D. Evaluation of Care E. Cost Effectiveness F. Review G. Summary Section 4: Current Efforts A. Care Coordination Vendors B. Private or Public C. Medicare D. State Medicaid Programs E. Department of Veteran Affairs F. Private Sector Efforts G. Review H. Summary Section 5: Social Determinants of Health A. What is Working and What is Not B. Measuring Outcomes C. Review D. Summary Section 6: Conclusion A. Summary B. Course Contributors C. Resources D. References E. Congratulations! F. Exam G. BrainSparks

Staff Writer: Jessica Cairns, RN, RAC-CT, CMAC
Jessica has almost 15 years of experience in nursing and 10 years in MDS/PAC working with organizations for the purposes of assessment, reimbursement, training, organizational, and leadership development. In these roles, she has acted as a consultant and auditor. Jessica has written content for diverse healthcare topics, including health and human services, compliance and more. Disclosure: Jessica Cairns, RN, RAC-CT, CMAC has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Beginner level Social Workers; Case Managers; Nurses; in the following settings: All Healthcare Settings.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.