Why Care Management Thrives with a Program Manager

It is generally accepted that a successful care management program requires an effective physician and nurse leader to oversee the program in conjunction with a governance team. This leadership team defines the organization’s care management vision and identifies strategic priorities.

The Care Management Leadership Structure

Under a typical care management structure, team members take on specific responsibilities:

  • The physician leader acts as an influencer and a point of contact for the primary care physicians participating in the care management program.
  • The nurse leader is the point of contact for care managers and care coordinators; they ensure that the front-line staff have the support, training, and resources available to provide top-of-license patient care coordination.
  • The governance team is comprised of selected business and clinical executive leaders within the organization—such as the CEO, CMO, CNO, and CIO. If the organization has an accountable care group or separate business intelligence groups, they will be included as well. The governance team defines the Population Health vision and incorporates care management needs and priorities in their strategic and IT roadmaps.

A Care Management Program Manager Ensures Work Is Ongoing and Operationalized

Although the above structure is critical for a care management program to succeed, there is also a strong case for a care management program manager. Once an organization has established a care management program, the work of translating strategic decisions into tactics and operationalizing them is ongoing.

When initiating the care management program or leading initial automation, the program manager’s role may include:

  • Translating the organization’s care management program vision into specific strategies and tactics.
  • Translating the organization’s vision for care management into operational practices.
  • Defining and refining content needed to support the program.
  • Building relationships with primary care clinicians to attain buy-in as the program grows.
  • Coordinating care management technical needs with other system IT projects—such as implementing Enterprise Master Patient Identification for planned data sources and implementing care management software and integration projects to enable the bidirectional flow of information between ambulatory care managers and other care teams.
  • Acquiring and use of multiple (EMR, claims, HIE) data sources needed to provide a holistic view of patient needs.
  • Facilitating development of policies and training program planning with associated curriculum, training delivery, and mentoring.
  • Overseeing analytics; and translating regulatory, payer, and management needs into specific measures and reports.

Once established, the care management program manager oversees: ongoing program evaluation and improvement; contributes to budget planning, justification, and approval; change management and program maintenance; and ongoing expansions to the care program. With the oversight of the care management leaders and the governance team, the types of activities the care management program manager performs are:

  • Participating in analytics design and evaluation of program performance.
  • Identifying improvement opportunities, and identifying specific clinical, operational, and financial goals and results.
  • Facilitating the shift to patient-centric, team-based delivery.
  • Driving patient engagement tactics.
  • Providing program updates and recommendations to leadership.
  • Overseeing data acquisition and data quality activities to support new patient populations for patient outreach.
  • Attending care management thought leadership conferences and keeping apprised of national trends in Care Management.
  • Conducting outreach to PCPs and care teams to assess how the program is working and identifying opportunities for improvement.
  • Facilitating shared learning across practices.
  • Managing various incremental program extensions—including, IT, analytics, clinical, social work, pharmacy, and mental health.
  • Leading process redesign to improve workflow and results.
  • Overseeing updates of policies, planning training programs with associated curriculum, delivering training, and mentoring existing staff and new hires.
  • Providing input to program budget and resource planning.
  • Negotiating contracts (software, third-party content, claims detail, etc.).
  • Potentially, supervising project managers as the program grows and expands.

Choosing the Right Care Management Program Manager

Ideally, the care management program manager is a high-energy influencer; facilitator; and relationship builder with project management, budgeting, clinical, and healthcare analytics expertise. They should also have process improvement experience so they can facilitate PDCA cycles to achieve outcomes improvement.

With strategic selection of a care management program manager, the program will thrive and grow, add new patient populations, measure outcomes, optimize performance, align staff performance, and achieve results.

Additional Reading

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

  1. The 3 Must-Have Qualities of a Care Management System
  2. How Care Management Done Right Improves Patient Satisfaction and ROI
  3. How Care Management Improves Performance for Clinicians, Compliance with MACRA, and Outcomes for Patients Like Olivia
  4. Introducing the Breakthrough Health Catalyst Care Management Product Suite
  5. The Case for Care Management: Arline’s Story
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