Care Coordination RFI

Request for Information: Care Coordination

Issued by
The Naomi Prawer Kadar Foundation, Inc.
Key Dates
Release date: June 12, 2019
Respond by: January 1, 2020
Send your responses to Please use the subject line: RFI: Care Coordination – Your Organization or Name

Please note that this request is for informational purposes only and is not a solicitation for grant applications. We are not currently accepting grant applications or inquiries. You can learn about our grant process here on our website.



The Naomi Foundation seeks input regarding the potential development of new funding streams to support models of care coordination/patient navigation in healthcare settings. Responses submitted through this request for information (RFI) will provide insights about current models, best practices, trends, and needs in the field with the goal of identifying human-centric solutions to challenges that patients and their families face in varied treatment settings.


As life expectancy has increased across the world, so have the number of chronic conditions affecting individuals. The consequences of this and other trends include increases in preventable hospital admissions, medication errors, duplication of care, conflicting medical advice, and unnecessary pain and suffering.[1] Gaps in quality of healthcare as well as rising costs have led to interest in solutions that will improve the effectiveness of healthcare provision and make the process more seamless to navigate.

One of the greatest challenges reported by patients and families today is a feeling of disconnect and a lack of integration among services and providers. In today’s fragmented healthcare environment, it can be difficult to remain knowledgeable about issues that affect our treatment, and to navigate the complexities of the healthcare system. Care coordination is a model that seeks to address the sense of isolation and confusion that many experience in navigating healthcare systems. At its core is the value of relational coordination, or an emphasis on the quality of communication and relationships among patients, families, providers, and other partners in healthcare delivery. According to the New England Journal of Medicine, “care coordination synchronizes the delivery of a patient’s health care…to improve health outcomes by ensuring that care from disparate providers is not delivered in silos, and to help reduce health care costs by eliminating redundant tests and procedures.”[2] Care coordination is characterized by a focus on the holistic needs of the patient, easy access to services and providers, effective care plan transitions, and the provision of clear communication and information.

Though the field is relatively new, research has shown that various models of care coordination have been positively associated with enhanced patient satisfaction; decreased unnecessary office and emergency room visits; reduced unplanned hospitalizations; lower expenses for patients and families; less time spent on coordinating care; less impact on employment and school attendance; ease of getting referrals; and decreased barriers to care.[3]

Information Requested

The Naomi Foundation’s priorities include leadership in education and advancements in healthcare that create lasting impact. More broadly, we value innovations that are meaningful on both an individual and a societal level. In line with this mission, the foundation is requesting information relating to needs and strategies in the area of care coordination/patient navigation. This RFI is an opportunity to inform the foundation’s thinking about effective ways to improve the experience of healthcare delivery for individuals, especially approaches that preserve the agency and dignity of patients as they deal with life’s most trying circumstances. We seek input from health professionals and other experts on the following questions and any additional information pertinent to the topic:

  • What models of care coordination are most prevalent, feasible, and/or effective? Are there specific approaches that are favored? If so, why?
  • Which specialized professionals are best positioned to be care coordination providers (e.g., registered nurses, social workers, etc.)? Why?
  • Are there certain populations or types of health issues that are most likely to benefit from care coordination services? If so, please describe.
  • What are best practices and needs regarding the training and education of professionals to be effective care coordination providers and leaders?
  • Are there notable institutions and/or individuals in the field of care coordination whom we should know about?
  • Where might funding be best directed in order to support the growth and success of care coordination models?

We welcome your written comments to the questions above, and would also be happy to arrange a phone or in-person interview. We invite you to share existing papers or literature that will shed light on the issue, and to introduce us to colleagues who are positioned to help us on our learning journey.

Please send your responses to


Additional Information

The Naomi Foundation extends its sincere gratitude to those who have taken the time to share their expertise and insights with our team.

Please be aware that this RFI is for internal education and planning purposes only and should not be construed as a solicitation for grant applications or a commitment for funding of any kind. Participation is voluntary, without compensation, and will not bear upon future funding decisions by the Naomi Foundation. The foundation will use the information submitted in response to this RFI at its discretion. You agree that you will not submit any information that may be considered business sensitive, proprietary, privileged or otherwise confidential or that is protected by applicable laws (including without limitation any information protected by the Health Insurance Portability and Accountability Act (HIPAA) or other data privacy laws) or that you are otherwise under an obligation not to disclose or keep confidential. The Foundation will not pay for or reimburse any information or administrative costs incurred in response to this RFI. We will endeavor to acknowledge receipt of information and answer questions and comments by responders, but may not be able to do so with respect to every submission.


Please direct any further inquiries to



[1] Lamb, G. (2013).  Care Coordination: The Game Changer – How Nursing is Revolutionizing Quality Care. Silver Spring, MD: American Nurses Association.

[2] What Is Care Coordination? (January 1, 2018). In NEJM Catalyst. Retrieved from

[3] See, for example:

●        Antonelli, R.C., Stille, C.J., & Antonelli, D.M. (2008). Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes. Pediatrics, 122(1).

●        Cooley, W.C., McAllister, J.W., Sherrieb, K., & Kuhlthau, K. (2009). Improved outcomes associated with medical home implementation in pediatric primary care. Pediatrics, 124(1), 358–364.

●        Palfrey, J.S., Sofis, L.A., Davidson, E.J., Liu, J., Freeman, L., & Ganz, M.L. (2004). Pediatric Alliance for Coordinated Care. The Pediatric Alliance for Coordinated Care: evaluation of a medical home model. Pediatrics, 113(5), 1507–1516.

●        Turchi, R.M., Berhane, Z., Bethell, C., Pomponio, A., Antonelli, R., & Minkovitz, C.S. (2009). Care coordination for CSHCN: associations with family-provider relations and family/child outcomes. Pediatrics, 124(4), S428–S434.

●        Wood, D.L., McCaskill, Q.E., Winterbauer, N., et al. (2009). A multi-method assessment of satisfaction with services in the medical home by parents of children and youth with special health care needs (CYSHCN). Maternal Child Health, 13(1), 5–17.