The idea of care management—managing a selected set of individuals to focus on reduced cost and better quality of care—has been around for a long time, primarily established in the payer space. However, with the growth of value-based incentives and risk-based contracting, healthcare provider organizations have started to think of care management, also called “complex care” and “disease management,” in the context of population health strategies.
Care management, done at its best, will reduce the cost and increase the quality of care for those individuals identified in the program. While Medicare data suggests that only 5 percent of a healthcare organization’s population consumes 50 percent of its resources, health systems must look beyond that 5 percent and also use a strategy that will allow them to identify and work with the people they will impact the most.
There are three basic categories of Care Management solutions on the market today:
- EMR suppliers: provider organizations have spent tens to hundreds of millions of dollars deploying EMR products for workflow and documentation at the point of care.
- Health plans: in a fee-for-service and volume-based world, only the health plan was financially incented to address the top 5 percent utilizer members. These programs were often referred to as “case management.” These case management products for health plans are well established and feature rich—if you are a health plan
- Standalone products: as care management shifts from health plans to providers, a new crop of population health and care management products has risen to the surface. This includes big name players who acquired products and services, and small independent startups.
We believe a care management program must be able to answer the following questions:
- Are we managing the right group of people?
- Are we having an impact for those people?
- Is there variation between care teams that may help us identify and communicate best practice?
- Is there an opportunity to change how we identify people or direct them to a different level of support that can positively impact health and program costs?
Additionally, the entire care team, along with the patient, can communicate and have dialogue through the suite, developing relationships that help and encourage patient engagement.