title: Disability care coordination organizations: improving health and function in people with disabilities.
abstract: Disability care coordination organizations (DCCOs) combine attributes of the medical home model and community nursing. Teams of nurses and social workers collaborate with the client to arrange disability-competent medical and social services. This article synthesizes observational findings from site visits to approximately half of the DCCOs operating in 2004. DCCOs have 6 core clinical activities: comprehensive assessment; self-directed, person-centered planning; health visit support; centralized medical-social record; community resource engagement; and constant communication. We also identified 3 core business competencies: service coordination, patient education/behavioral modification, and continuous enhancement of disability competency. Each DCCO started as a new company rather than as a product line of an existing business, and each included the target population in the design stage. Most DCCOs contract with state Medicaid agencies under a prepaid capitation arrangement, and some also enroll Medicare beneficiaries. Capitated DCCOs retain cost savings and may be financially stronger than fee-for-service DCCOs. Although studies suggest that DCCOs improve coordination and clinical outcomes while reducing costs, the current evidence has not been peer reviewed.
authors.affiliation: Center for Study of Chronic Illness and Disability, George Mason University, Fairfax, VA 22030, USA. spalsbo@gmu.edu
authors.forename: Susan E
authors.initials: SE
authors.lastname: Palsbo
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Mastal
authors.forename: Lolita T
authors.initials: LT
authors.lastname: O'Donnell
mesh_terms: D000203:Activities of Daily Living; D001291:Attitude of Health Personnel; D002204:Capitation Fee / Q000458:organization & administration; D019090:Case Management / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D006293:Health Promotion / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D008404:Massachusetts; D008484:Medicaid; D006278:Medicare; D008910:Minnesota; D017146:Models, Organizational; D009518:New York; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D036301:Qualitative Research; D012947:Social Work / Q000458:organization & administration*; D014707:Vermont; D014922:Wisconsin