How Care Management Done Right Improves Patient Satisfaction and ROI

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Care management has taken a central role in the national conversation around population health management, and with good reason. As a foundational element of an effective population health strategy, effective care coordination enables health systems to take better care of patients while ultimately reducing redundant and unnecessary utilization.

Successful Care Management in Action

There are numerous programs around the country that have demonstrated success in care management and coordination. Take the Massachusetts General Hospital Evaluation of Medicare Care Management for High Cost Beneficiaries Demonstration, the pilot site of what is now the Partners iCMP program (with which, in full disclosure, I am affiliated). This program, which targeted beneficiaries with HCC risk scores >2.0 and annual costs of at least $2,000, or scores >3.0 with costs >$1,000, aimed to provide longitudinal care coordination for these complex patients through an embedded, primary care-centric program. Internal analysis provides a little more color around these patients. On average, they took 12.6 medications, had 3.4 hospitalizations per year and had average total medical expenses of around $24,000. By leveraging experienced nurse care managers to work with these patients and their caregivers, the program yielded both clinical and financial success. Through an independent evaluator (commissioned by CMS), the program was assessed after the first three years and the results were impressive. Hospitalization rates were 20 percent lower than the comparison group, ED rates were 13 percent lower for enrolled patients, and mortality per annum was 16 percent (compared to 20 percent for the control group). Furthermore, there was a return on investment of $2.65 for every $1 spent, with 7 percent in annual net savings (after accounting for management fees). In short, doing the right thing for patients proved financially viable.

The success of this program is not an isolated example. The Guided Care program in urban Maryland reported higher “aggregate quality of chronic care” at 32 months, and improved satisfaction in terms of patient/family communication and knowledge of their patients’ clinical characteristics. This was within the context of an average net savings of $75,000 for each Guided Care nurse per year. Geisinger’s ProvenHealth Navigator program showed improved performance on HEDIS measures, improved patient satisfaction (72 percent of patients believed quality of care improved) and yielded a decrease in total expenditure by 8 percent over four years. These examples are a few among many.

It is easy to understand how care management provides improved clinical outcomes for patients and improved satisfaction for providers. As a primary care doctor, I am ever grateful for the support of my care manager, Caroline, and I am reminded of the impact of her work daily. Caroline has been instrumental in treating my patient, Mr. M, a 62-year-old male with a history of coronary artery disease (status post bypass surgery), end-stage renal disease, and diabetes (complicated by near blindness). I used to cringe at the thought of this patient attempting to correctly take his complicated pill regimen without even being able to see the pills. With the support of our care manager, Mr. M has been granted a smart pill box, has support getting to and from his appointments, has been connected to a social worker, and most importantly, has a point person to contact to help clear things up when he’s confused after specialist visits. Mr. M’s health has benefited immensely from care management, as has my confidence in my clinic’s ability to support him through the trials he faces daily.

The clinical benefits of care management are obvious; understanding how it yields cost reduction is trickier. While there are many reasons underlying the cost savings noted in the examples above, ultimately, coordinating care is an investment in outpatient spend that reduces inpatient spend. By coordinating care between primary care and specialists, care management programs ensure there is less redundancy in studies ordered and better sharing of information and records. Care managers are skilled at medication reconciliation, and in doing so, avoid medical errors due to patients incorrectly taking medications. Care managers can ensure patients make it to their appointments, thus minimizing use of the emergency department for non-emergent matters. Ultimately, by coordinating outpatient care, inpatient spend becomes less necessary.

The Role of Analytics, Facilities, and Culture in Care Management

Even the most well-structured care management program will not yield clinical or financial success in isolation. Strong data analytics are needed to pick the right patients at the right time, and determine who will most benefit from the extra attention and support that care management provides. Health Catalyst® can be instrumental in supporting success in this step through its suite of Care Management applications.

A strong site of care strategy is also essential; even the most robust care management program may not be able to avoid a preventable ED visit if there is no same-day clinic access or urgent care strategy within a health system.

Finally, culture is king. All members of the care team – physicians, pharmacists, specialists –  must buy into care management and, to varying degrees, engage in the care coordination process for it to be successful. This relies on institutional support of care management, garnered through thoughtful governance, staffing, and messaging.

Success in population health management will never be based on a single program. With that said, the numerous examples of high functioning, cost-saving care management programs across the country suggest that a well-structured, resourced, and integrated care management program can have a profound effect on clinical outcomes, while yielding cost savings.

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