Coordination of care is the process by which a patient’s team of providers cooperatively help coordinate care management and ensure access to quality, cost-effective care.

Disruptions in care and lack of timely communication may result in delays in treatment and possibly poor health outcomes for patients. Through communication, planning, and collaboration, continuity and coordination of care can be achieved to ultimately meet patients’ needs.

To help facilitate continuous and appropriate care for patients, our quality program monitors, assesses, and identifies opportunities to act and improve upon continuity and coordination of care across settings and between providers.

Our quality programs monitor for:

• Coordination of care –
  • During transitions between inpatient settings, such as hospitals, skilled nursing facilities, or hospice.
  • In outpatient settings, such as rehabilitation centers, emergency departments, or surgery centers.
  • Between any setting type (for example, medical to medical, medical to behavioral health).
  • When patients move between providers (for example, from a specialist to a primary care provider or between medical and behavioral health providers).
• Notification of patients and their transition from providers who have been terminated from a network.
• Patients who qualify for continued coverage of services rendered by providers who have been terminated from a network for reasons other than quality.

Cigna Healthcare^® has developed tools based on our assessments that may serve as models for exchanging clinical information throughout the coordination of care. The Continuity and Coordination of Care tools are available to download from the Cigna for Health Care Professionals website (CignaforHCP.com).

The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers.