Care Coordination Burden Snapshot
A 12-question scored look at the coordination load on your household.
Already enrolled in a care management program?
If your loved one is on Chronic Care Management (CCM), Remote Patient Monitoring (RPM), GUIDE, Principal Illness Navigation, or a similar program through their provider — those programs identify clinical needs and stay in regular contact.
This snapshot measures something different: whether your household has the capacity to act on what the program is identifying. Records, scheduling, vendors, transportation, resource activation, and family alignment all happen outside the clinical workflow — and usually fall on one family member. The two work together, not against each other.
Answer 12 questions. There are no clinical questions. Each scores 0, 1, or 2 based on what fits your household. Takes about 3 minutes. Free, anonymous, no signup required to take the snapshot.
1 Care complexity
How many providers, portals, and open loops are in play right now.
1 How many active providers or services are involved right now?
PCP, specialists, home health, therapy, DME, pharmacy, etc.
2 How many separate health systems or patient portals?
3 Are there unresolved referrals, orders, appointments, records, or pharmacy issues?
2 Household support
How help with daily activities, household services, and vendors is being managed.
4 Does help with daily activities (bathing, dressing, mobility, personal care) need attention?
5 Who is managing meals, transport, supplies, medication pickup, and vendors?
3 Family operator
Who is acting as the unpaid project manager, and how reachable they are.
6 Is one family member acting as the unpaid project manager?
7 Is the key family operator local and reachable during business hours?
8 Is a spouse or other household member also in CCM, RPM, GUIDE, PIN, home health, or similar?
4 Execution and overload
Whether recommended resources have actually started, transitions are ahead, and the household is keeping up.
9 Has a resource, service, or support been recommended but never actually started?
Transport, meals, pharmacy delivery, home health, DME, respite, caregiver support, etc.
10 Has there been a recent or upcoming transition?
Hospital, SNF, ED, surgery, home health start, new PCP.
11 Is the patient or family overwhelmed by calls, reminders, portals, or repeated explanations?
12 Do you want someone to actually handle coordination — not just provide phone numbers?