When care management programs fail, it’s rarely because they’re ineffective. Most likely, it’s because health systems don’t have an accurate way to measure care management’s success and, therefore, don’t fully understand (or communicate) its impact on outcomes improvement or cost savings.
For care management programs to be successful and demonstrate their value around critical metrics, such as readmissions, health systems need effective technologies and tools that leverage data to give leaders visibility into care management’s processes (e.g., how it identifies high-risk and rising-risk patients and assigns them appropriately to care managers) and overall impact.
This article explains the challenges health systems encounter when it comes to demonstrating and understanding the measurable value of their care management programs, and how analytics-driven applications can help prove care management’s positive impact on outcomes.
Health system leaders must constantly measure the success of their care management programs to continue allocating the resources required for them to improve outcomes and lower costs. Health systems have varying perspectives on care management, depending on whether they’ve transitioned to value-based care (VBC) or still use a fee-for-service (FFS) payment model. Organizations that have taken on more risk under VBC tend to be more motivated to invest in care management to mitigate that risk, while those who have stayed with, or are returning to, FFS will see less value in care management.
Before the 2010 Affordable Care Act (ACA) provisions incentivized care management by reimbursing health systems for certain care management activities, ambulatory care management programs were not widespread. Even though many healthcare leaders understood the importance of care management in population health management, they still made decisions based on the financial bottom line. Today, as the healthcare ecosystem goes back and forth between VBC and FFS, care management is often caught in a tug of war for resources and legitimacy.
Without technologies and metrics to prove its value, care management struggles to get credit for outcomes improvement, even when the link between care management interventions and better outcomes seems otherwise clear. For example, some health systems may implement a care management program in their acute care and ambulatory settings in which they call all patients within 48 hours of discharge. Even though organizations have seen a decrease in readmissions after implementing such programs, care managers rarely have the necessary data to connect readmission reductions directly to their intervention. C-suite leaders may be reluctant to give care management full credit for reducing readmissions, as other departments will compete for that recognition.
To build and demonstrate care management’s value, organizations need technologies, processes, and tools to answer several key questions:
Care management technology innovators are introducing tools that address the questions above and, with better tracking and support of care management activities, give organizations the data to demonstrate the value of their programs. The Health Catalyst Care Management Suite, for example, includes five mobile applications that, separately or as an entire suite, support effective, sustainable care management:
The Patient Stratification application helps care managers identify the most impactable patients in their populations for care management (those with the highest return on engagement potential). Care management resources can be very expensive, and many health systems have a lot of potential candidates for care management. A patient stratification tool helps organizations allocate often-scarce resources most effectively by understanding which patients will benefit most from outreach.
With the Patient Intake tool, care management teams can track and assess their program’s progress and productivity. Patient intake data gives care managers a meaningful way to demonstrate to administration and high-level leadership that they’ve appropriately distributed patients among the care management team. A patient intake tool uses the risk score data from the patient stratification process to determine how to best assign each patient to a care manager. Patients are matched with care managers based on the complexity of the patient’s situation, diagnosis, and need for psychosocial support. This creates transparency in the care management process and workflow, from identification through discharge.
The Care Coordination app gives care managers a more effective workflow tool to coordinate patient care. Care managers have previously used less efficient tools (e.g., Outlook and Excel) to manage workflow. As care management increasingly includes more complex data, managers need care coordination tools that can streamline the process, from ingesting data and developing care plans to sending reminders for upcoming activities. With an efficient app, care managers can spend more time with patients and less time managing workflows.
The Care Companion app empowers patients to take an active role in their outcomes by helping patients better understand and get involved in their care plans. Patients can engage directly with their care managers from their mobile devices, and research has positively linked patient engagement with improved outcomes.
Care managers can use the Care Team Insights tool to track their program’s performance. This app breaks down the clinical, EMR, and transactional data from the patient intake and care coordination tools to give a robust view of process metrics and demonstrate ROI. Care managers can easily view key program metrics—and share them with leadership:
Technologies that provide a comprehensive, data-driven view of care management’s performance—how it’s improving care across the organization (including ROI)—can help healthcare leaders, as well as the entire organization, understand care management’s positive impact on outcomes and cost.
With visibility into all aspects of care management—from the patient stratification and intake processes to patient engagement, workflow, and key performance metrics—analytics-driven applications give these leaders an accurate, accessible way to demonstrate the important role care management plays within their organizations.
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