On the Population Health and Cost Transformation Stage, Care Management Is the Star

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When it comes to care management, a critical but frequently missing component of population health and cost management, most healthcare organizations are operating in a far-from-perfect world. Their ambulatory care management programs (if they even have one) are up against a multitude of challenges: demonstrating ROI, accessing disparate data, engaging patients, etc. The list of roadblocks is long.

But The Care Management Show, designed to educate, entertain, and spark curiosity, gives health systems hope—it demonstrates in an interactive, funny, and easy-to-understand way how care management should work.

Millrock Hospital: From Care Management Averse to Care Management Champion

The Care Management Show opens with a news anchor sharing an all-too-familiar soundbite: “Millrock Hospital’s earnings are way down. Five percent of its patient population is consuming as much as 50 percent of its resources.” Millrock’s CEO takes the stage and says, in a state of red-faced panic, “Our ED usage is off the charts right now. We’ve got to come up with some way to get this under control. I’m going to do the one thing I swore I’d never do: care management.”

As the 18-minute show continues, we witness Millrock’s progression from care management averse to care management champion. The show’s lighthearted look at this serious subject demonstrates how roadblocks to care management success (data integration, patient stratification and intake, care coordination, patient engagement, and performance measurement) can be overcome with innovative technology, such as the Health Catalyst® Care Management Suite.

Meet Joe: The Patient We All Know

As the show continues, Millrock starts down the care management path by identifying patients, like Joe, that its small number of care managers are most likely to impact.

Joe visited the Millrock ED five times last month and, like so many people in the U.S., struggles with the daily challenges of lowering his risk of serious health complications by adhering to a care plan. Millrock places Joe in its chronic care management program. When Joe’s care manager, Ann, visits him at home, she gets a glimpse of the unhealthy lifestyle that’s landed him in the ED so many times. Laughter consumes the stage when Joe describes his workout routine: “When I have spicy hot CHEETOS™, that’s when I really start to feel the burn.”

To clear the many hurdles on his way to better health, Ann provides Joe with a variety of care management resources: a care management plan, a pharmacist to conduct an inventory and reconciliation of his medications, and a mobile care management application that lets Joe see his appointments and text his care team with questions, comments, and concerns.

Joe’s extended care team (his physician, nurses, and family, etc.) partners with him to improve his health and lower his risk of major complications and hospitalization. The mobile care management app keeps Joe engaged and his care team up to speed on his real health status.

Now Joe sees his primary care physician on a regular basis and takes his medications. His outcomes improve. His hemoglobin A1c is normal and he loses weight. His care team continuously gathers data to determine which interventions are having the biggest impact.

Toward the end of the show, the news anchor’s tune has changed: “Millrock hospital is reporting improved patient outcomes and positive profits.” The show proves that care management done right works at the patient and system level.

How Care Management Should Work

Earlier approaches to care management held the promise of improving care and lowering cost, but they haven’t consistently delivered the required data integration, care team communication, or patient engagement. New data-driven, technology-supported approaches to care management are transforming this essential aspect of healthcare into a highly effective quality improvement tool that’s changing the lives of patients like Joe.

Fully integrated care management approaches prevent patients like Joe from falling through health system cracks: patients who tell their doctors they’re watching their cholesterol, but aren’t; patients who think they are getting exercise, but, outside of a CHEETOS-induced burn, aren’t. Effective, data-driven care management solutions integrate all aspects of patient care (physicians, nurses, hospital executives, and family) to define health status and risk, recommend interventions, and notify care teams about important changes or setbacks.

Healthcare needs to think beyond the traditional walls of care delivery to a model that leverages technology to engage our “Joes” where they are: in their living rooms, offices, or care settings.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

  1. Is Your Care Management Program Working: A Guide to ROI Challenges and Solutions
  2. A Guide to Care Management: Five Competencies Every Health System Must Have
  3. How Care Management Done Right Improves Patient Satisfaction and ROI
  4. Introducing the Breakthrough Health Catalyst Care Management Product Suite
  5. The 3 Must-Have Qualities of a Care Management System
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