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What is Care Management?

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According to research, health care spending for people with five or more chronic conditions is 17 times higher than for people with no chronic conditions.

Although these patients represent a small proportion of the population, healthcare expenditures are disproportionately high.  

What is Care Management?

Care management is an innovative solution that can reduce costs while improving quality for people with complex health care needs.

These programs aim to assist patients in managing their medical conditions by implementing a set of activities.   

Care coordination and care navigation for medical, social, and behavioral needs are at the core of care management.

That includes hands-on approaches like medication management, engaging with patients and their families, access to community support, use of technology, and available resources, all in an effort to achieve better experience and better wellbeing.   

Benefits of a Care Program

  • Improved quality of patient care. 
  • Improved patient’s health status. 
  • Reduced hospitalizations and readmissions. 
  • Reduced healthcare costs. 
  • Reduce the need for expensive medical services. 
  • Boost patient engagement by educating. 
  • Link to external support groups. 
  • Better care coordination among multiple providers. 
  • Medication management. 

What is the Goal of Care Management?

The ultimate goal of care management is to improve the patient’s health and wellness status.

It is hard to quantifiably measure whether or not the patient outcome has improved and by how much. Therefore, a subset of measurable goals is tracked such as reduced hospitalizations, reduced readmissions, eliminating duplication of services, and increasing the patient’s self-care.   

Costs and quality outcomes are correlated to one another.

Patients with improved quality outcomes require fewer hospitalizations and emergency visits. Inadequate care causes worse patient outcomes, which leads to higher costs and expenditures.   

For employers, offering a holistic approach to employees improves population health, increases employee satisfaction, and lowers costs.

Care management is not sufficient enough to replace primary care, it is there to broaden it and ease the lives of employees with complex health care needs.   

What is the Difference between Disease Management & Care Management?

Disease management is condition-specific, meaning it is aimed at managing a single medical condition, such as diabetes or asthma by self-care efforts. The goal is to educate and teach the patient how to improve their health and manage it independently, with a certain degree of supervision and guidance from healthcare professionals.   

Care management on the other hand, focuses on managing multiple comorbidities as well as social and behavioral issues that come with it. Care coordination for a number of conditions and maintaining communication between the patient and physicians is at the core of care management. It offers differing levels of intervention depending on the needs of the patient.   

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Key Elements of a Successful Program

  • Patient engagement – Informing patients about their care planning as well as teaching patients and their caregivers about their condition, and how to recognize worsening symptoms.  
  • Care coordination – Help navigate patients through the complex healthcare system, with the help of dedicated care teams that communicate and collaborate on patient assessment, care planning, and treatment. Care management aims to successfully coordinate the patient, the primary care provider, physical therapists, and all other specialty providers, so there is no duplication in services or medication conflict.   
  • Performance measurement – Reports that show how the care team performed and how the patient’s health improved after analyzing gathered data.  
  • Data integration – The sharing of electronic health records (EHR) between physicians and care managers provides a lot of insight into the patient’s health status. A number of algorithm-driven statistical models use multiple inputs to predict high-risk opportunities for care management, candidates, as well as future healthcare costs.  
  • External support – Besides medical attention and care, one other key element of a successful care program is pointing patients to the right community support groups, providing resources, and making referrals and recommendations for local health programs.  

To summarize, care management provides more efficient and coordinated healthcare for patients, improves outcomes, and reduces costs for all involved. 

Written by Shortlister Editorial Team
Written by Shortlister Editorial Team