Care Management Fundamentals

Healthcare spending is rising again after record low increases between 2009 and 2012.1 Pressure to control costs continues to increase as consumers, businesses and healthcare organizations scramble to manage expenses.

Managing the health of populations with chronic conditions is a key strategy to help control and reverse rising costs. The numbers are significant: 84% of U.S. healthcare dollars are spent on patients with chronic conditions2, and just 5% of the population accounts for almost half of U.S. healthcare spending3. Improving outcomes for these patient populations can yield big benefits—and increase the quality of life for individual patients.

As episodic fee-for-service payment transitions to performance-based reimbursement, providers and healthcare organizations are increasingly being asked to deliver better outcomes at a contained rate. The proof is in the numbers: the first quarter of 2014 experienced the largest increase in lives covered by ACOs since 2012, and 626 U.S.-based ACOs now provide care for 20.5 million patients4. Estimates show that between 10 and 20% of most healthcare organizations' revenue is currently risked-based5. Providers expect to assume more risk moving forward, and are making appropriate investments in staff and technology.

To Learn more download the whitepaper,
Reimagining Provider-based Care Management

Care Management Hurdles

Common Care Manager Issues

  • Which patients should be prioritized, and why?
  • What's the best, evidence-based approach to improve my patient's co-morbidities?
  • How can I successfully educate my patients?
  • How do I know my interventions are working?

When equipped with care management tools, provider-based care managers can bridge the gap between identifying high-expense patients that need intervention and delivering the holistic, patient-centered care that helps improve patient lives and lower treatment costs. This isn't a small leap: when implementing care management, provider organizations must

  • define their care management goals
  • determine whether to deploy care managers in a clinical, enterprise or hybrid model
  • prepare their care managers to confidently address challenging situations and large case loads

Effective care management isn't easy. Overseeing a large patient population, providing personalized, evidence-based care that helps each patient, creating care plans, documenting interventions, and following up—can be daunting. Economics dictate that care managers handle large caseloads. While caseloads vary by model and practice, information collected by McKesson indicates that care managers may be expected to support 65 – 90 patients at a time6. Disease managers, who support patients with controlled conditions through non-intensive interventions such as patient education, prevention and health maintenance, may simultaneously oversee 150 – 300 patients7. Relying on excel spreadsheets and home-grown interventions opens up opportunity for quality and care gaps—and employee frustration .

Automated Help Wanted

Regardless of your care management model and goals, busy care managers require automated support. Manpower alone can't efficiently manage challenges resulting from overburdened providers, patients with multiple conditions, and the increasing number of care settings and associated transitions in care. Busy patients appreciate how an informed, knowledgeable health partner—their care manager—who is equipped with electronic tools, can communicate with them in a convenient, flexible time and setting.

Now's the time to start developing provider, care manager and enterprise confidence in your ability to improve patient outcomes and manage cost and risk. Download the eBook, Reimagining Provider-based Care Management, to learn more.

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1Wall Street Journal
2Robert Wood Johnson Foundation
3National Institute for Healthcare Management
4Leavitt Partners
5IDC Health Insights
5" How Care Management Evolves with Population Management", McKesson
6Anecdotal caseload data
7Anecdotal caseload data