iPatientCare Blog - How Care Management Decreases Health Risks and Healthcare Costs

How Care Management Decreases Health Risks and Healthcare Costs

Does care management deliver important outcomes such as improvement in patient clinical measures, satisfaction with care, or reduced cost to the health care system? We have heard doctors asking such questions when it comes to ‘ Care Management’. The answer to this, is a qualified “yes,” depending on outcomes, conditions, and on how the care management was implemented. Let us understand the basics of Care Management and see how it helps.

Care Management: An Effective Population Health Management Strategy

With the growth of value-based incentives and risk-based contracting, healthcare organizations have started to think of care management, also called “disease management,” in the context of population health strategies. It is increasingly considered as a common and critical component of effective population health strategies. Care management is a set of activities designed to assist patients in managing their medical conditions more effectively. The purpose is to improve patients’ health status, enhance the coordination of care, and reduce the overall cost of medical services. Patients who fall under the below-mentioned criteria can be enrolled for the Care Management program:

  1. Patients with multiple complex conditions
  2. Patients needing medical services of the highest cost
  3. Patients posing the highest clinical risk.

The Five Core Competencies of well-organized Care Management

  1. Data Integration: Aggregate, analyze, and deliver data at the right time to the right people across the continuum of care, from hospitals to pharmacies. We will learn about the role of EHR in data integration later in this article.
  2. Patient Stratification and Intake: Integrate current utilization and progressions, chronic conditions, active medications, social and behavioral determinants from different clinical and claims data sources. These sources are integrated into an analytics platform that allows patient stratification.
  3. Care Coordination: Promote timely, all-inclusive care team communication and collaboration on patient assessments, care planning, and interventions. The activities in the patient’s care plan are prioritized and distributed to the members of the care management team.
  4. Patient Engagement: Facilitate secure, real-time, multi-point messaging, assessments, and care planning to engage and support all care team members (patients, friends, families, care navigators, etc.) across multiple EMRs.
  5. Performance Measurement: Evaluate and report on care management program effectiveness using metrics and measures suitable for value-based contracting. Dashboards should display the impact of the program on a group of enrolled patients versus a control group of patients who are outside of the care management program.

How Care Management Works:

The key steps to implement Care Management Programs to deliver the needed services include:

  1. Identify population with modifiable risks – Multiple metrics and risk-based approaches are used to identify patients with modifiable risks and in need of care management services. This insight allows providers to offer care at the appropriate level and time.
  2. Align CM services to the needs of the population – With inputs from patients, the care management program is aligned to meet specific needs of populations with different modifiable risks. This promotes supportive, trusting relationships between providers and patients. Key services addressing the needs of particular populations include coordination of care, self-management support, and outreach.
  3. Identify, prepare, and integrate appropriate personnel – Interprofessional team-based approaches to care are implemented after identifying skills, training and license requirements in context with population needs and practice.

How EHR systems support Care management

The technology to support care management begins with the EMR and goes far beyond the mere digitization of a patient’s medical history. Some EHR systems can support a variety of care management areas including preventive and acute care, and chronic care management.

Here are some features within the EHR often used within care management:

  1. Electronic scheduling
  2. E-communication with providers/staff (e.g., instant messaging)
  3. Disease management tools
  4. Assessment tools
  5. Population management/reports (e.g., diabetic registry)
  6. Out of scope/target patients
  7. Personalized patient care plans
  8. Online goal setting tools or templates built within EHR
  9. Monitoring/flagging/reminders (e.g., follow-up appointments with patients)
  10. Referral management

How quality improvement strategies support the implementation of care management

Quality improvement in health care has been around for centuries. Now quality improvement includes developing and implementing strategies to improve the process of patient care and patient safety. Implementation of QI in care management has been shown to enhance the change process and create a culture of continuous change. The overall goal is to enhance the quality and efficiency of care delivered in the practice.

Why your Practice should Implement a Care Management Program?

Care management programs serve a vital role in today’s health care environment. From the initial identification of patients in need to coordination of care and communication across the healthcare continuum to evaluation of patient outcomes, care management provides whole-person and patient-centered care to help high-risk patients and their families effectively manage their conditions.

The upcoming Virtual User Conference (VUCON) hosted by iPatientCare features an introduction to Care Management initiatives designed to educate health care professionals and consumers of the benefits of care management services. Join us on Thursday, July 18 from 3:00 PM to 4:30 PM (EST) as we discuss the ins and outs of Care Management Initiatives.


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