Table.
Generating Ideas for Potential Interventions by Thinking Through Multilevel Drivers of Health Care Fragmentation
| Level of action (6P model) | Contributors to health care fragmentation and subsequent harms | Potential interventions |
|---|---|---|
| Patients (and caregivers) | Assumption that physicians are communicating with each other | Educate and encourage patients and caregivers to bring medical records, test reports, and medicine bottles to visits and report perceived gaps in communication |
| Providers (physicians) | Lack of communication with each other regarding their common patients | With appropriate incentives (see also Plans), improve communication among physicians for their common patients and create shared accountability |
| Practice settings | Lack of notifications for physicians when they are seeing a patient with many ambulatory physicians | Create alerts, notifying physicians when they are seeing patients who have many ambulatory physicians and encouraging communication among members of the care team |
| Plans (public and private payers) | Undervaluing of cognitive services, putting pressure on primary care physicians to see many patients per day | Increase compensation for cognitive services, enabling more time to be spent per patient |
| Failure to incentivize communication among physicians | Add financial (or other) incentives for primary care physicians and specialists to recognize their shared accountability for patient outcomes, fostering communication and teamlike processes | |
| Lack of use of claims to identify patients with highly fragmented care | Use claims data to identify patients with highly fragmented care and partner with physicians to reduce unnecessary fragmentation | |
| Purchasers (employers) | Lack of identification of fragmented care as an opportunity for improvement | Put pressure on public and private payers to hold them accountable for decreasing unnecessary fragmentation |
| Populations (communities) | Lack of consistent communication among community-based urgent care centers and patients' other physicians | Improve communication between urgent care centers and patients’ other physicians |