Care Coordination & Referrals
Expert articles and analysis related to care coordination & referrals.
AI Summary — Last 30 Days
Care coordination is being repositioned as the operating core of value-based specialty and post-acute models, with Blue Cross NC’s Advanced Kidney Care program tying nephrology partnerships, CKD/ESRD risk alignment, and outcomes-based accountability to earlier intervention and reduced avoidable utilization (HCTTF case study). At the same time, CMS under the Trump administration is pushing technology enablement and broader mandatory model momentum—alongside industry concern over prior authorization workflows, rural capacity, and nursing home readiness for LEAD ACO participation—making referral management, data integration, and cross-setting care teams strategic differentiators rather than back-office functions. Prisma Health’s embedded care managers, transition nurses, ED navigators, and interdisciplinary care-team pods show where high-performing ACO/CIN infrastructure is headed: real-time, frontline population health operations that can manage risk across primary care, hospitals, Medicaid high utilizers, and specialty referrals (Prisma Health strategy).
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