Care Coordination Q&A with Christina Goatee

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Christina Goatee, CMS

Christina Goatee, MSN, RN is a nurse consultant and the Centers for Medicare & Medicaid Services’ (CMS) subject matter expert for care coordination under the Quality Improvement Organization (QIO) Program. Her primary responsibilities include serving as a subject matter expert and overseeing Quality Innovation Network-QIOs’ (QIN-QIOs) quality improvement efforts in the areas of care transitions, behavioral health and coordination of care for Medicare beneficiaries. Prior to joining CMS in 2013, Goatee was an appeals nurse analyst with CareFirst BlueCross BlueShield and a nurse manager with the University of Maryland Medical Center. She earned a bachelor’s degree in nursing practice from the University of Maryland at Baltimore and a master’s degree in nursing management and leadership from Walden University. 

Q. Tell us how your background in nursing has prepared you for your new role as the care coordination lead for the CMS QIO Program.

My work in care coordination started during my time at the University of Maryland where I was a nurse manager in one of the critical care units of the hospital. When I ­first joined CMS, I worked at the Center for Medicare & Medicaid Innovation (CMMI), eventually serving as team lead for the Community-based Care Transitions Program (CCTP). We worked with more than 100 community-based organizations nationwide, which provided one-on-one coaching for beneficiaries discharged from the hospital. The goal of the CCTP was to reduce readmissions by 20 percent. We learned a lot from that five-year program, which concluded on January 31, 2017. I came to the QIO Program because of that work. Many of the QIN-QIOs did background work and mentoring for the community-based organizations involved in CCTP, and I wanted to learn more about quality improvement work.

Q. What are your primary objectives and priorities over the rest of this year?

We have a number of priorities. Among other things, we are preparing to review the most recent results from our care coordination work and developing Standards for Quality Improvement Reporting Excellence (SQUIRE) reports. Those reports provide a framework for reporting new knowledge about the unique interventions that the QIN-QIOs have used to improve health care. We are also looking to the future — determining our focus for the QIO Program’s next performance period. We are identifying success stories for sharing with other communities and continuing to integrate our activities across clinical focus areas; for example, we want to tie more of our care coordination work to other tasks like behavioral health. Behavioral health challenges can lead to hospital readmissions, so it is important for care coordination to consider that aspect of patients’ lives. Many primary care providers (PCPs) are starting to look at care coordination as a strategy for employing a psychologist to advise them on behavioral health issues or to oversee a patient’s care.

Q. What are some examples of innovative and successful initiatives that QIN-QIOs have undertaken to improve care coordination?

Some hospitals that QIN-QIOs work with have added a navigator — typically a social worker or nurse — to help troubleshoot follow-up appointments or resolve issues when a patient gets home from the hospital. For example, if the patient did not receive a necessary prescription, the navigator will ensure that one is provided. Some hospitals also have a pharmacist on staff who will work with a patient’s local pharmacist to ensure that certain medications can be safely taken at the same time.

Q. What can Medicare beneficiaries and their families do to ensure smooth transitions of care and avoid unnecessary hospital readmissions?

When a loved one is hospitalized, the family can become overly stressed. Having a good game plan for keeping and communicating care plans with the entire family is probably the best practice. It is good to have someone available upon discharge to provide an extra set of ears and to take notes. That person can reinforce the hospital’s directions at a more appropriate time for the patient. Also, it is important to have follow-up numbers established so that any questions or issues can be addressed as they occur and do not linger.

Q. Anything else you would like QIO News readers to know?

I am really excited to be here working on improving care transitions and behavioral health for our beneficiaries. I have been so impressed by the work that is being done in these areas. I am ever so appreciative of the efforts of the QIN-QIOs that are currently working on these tasks. Thank you for all of your hard work.