Care Coordination Aspect of Bariatric Surgery
On this week’s episode of Bariatric Friday, Kemal Erkan and Dr. Isaias Irgau join together to discuss the care coordination aspect of bariatric surgery. By nature, bariatric procedures require interdisciplinary knowledge and support from a variety of professionals, such as the surgeon, primary care provider, nutritionists, dietitians, endocrinologists, and others.
Care coordination is so critical in the bariatric process because it is not a standalone procedure. Dr. Irgau explains that it comprises three main facets, the medical component, the nutritional component, and the behavioral component. Care coordination ensures that these components are accounted for and flowing together for the patient in a seamless fashion. Trying to perform bariatric surgery by itself without consultation from other specialties has historically not been as successful.
Erkan mentions that many patients who present in the office with morbid obesity also have comorbidities such as diabetes, hypertension, and sleep apnea. Managing these conditions before and after surgery requires input from other specialists. What is unique about CHRIAS is its position within the United Medical ACO, which allows for full clinical integration. Powered by Oracle Health, the ACO follows a “one patient, one chart” model. Dr. Irgau notes that care coordination requires structural integration, more than just doctors knowing each other. Within the United Medical network, clinicians are able to see vital information and schedules from other practices. This eventually leads to better patient outcomes.
Next, Erkan asks what the common coordination challenges are before surgery. Problems such as missing paperwork, delayed clearances, lack of communication, and ineffective communication between referring consults and the bariatric surgeon can all be challenges in this process. The number of preoperative assessments that are required may be burdensome and time-consuming for the patient, but they are necessary to make sure that the procedure is done safely.
Postoperatively, there are risks for complications, non-compliance, and weight regain. Care coordination also impacts post-operative success by following up with patients and tracking their lab results, seeing how often patients are seeing their nutritionists, and seeing how well they are keeping up with their appointments. Patients have a busy life outside of medical treatment, so proper care coordination is vital for reminding them about appointments they may have. Patients also may not know what services are available to them, such as transportation offered by Medicaid. UM’s social workers can help get patients get the resources that they need.
Coordinated care also fits into value-based models because the principles that guide value-based models are reducing admissions, cutting costs, and making sure that there are good outcomes. Care coordination works on all of those tenets. If a patient is followed up on regularly, “then they are less likely to end up in the emergency room with a very high blood sugar level,” Dr. Irgau says. The days of taking care of a patient’s comprehensive needs with one provider are bygone. Every patient should have a full team of people supporting their needs from various perspectives. Primary care providers especially are key, as they are the ones who maintain a long-standing relationship with the patient. Education is also critical to make sure patients are active agents in their own care.