Solutions for the Health Industry

Hospital nurse and techIn a recent Special Report, How Care Management Evolves with Population Management, published by HealthLeaders Media, senior clinical, operations, finance, marketing, and information health leader respondents indicated that they plan to restructure their care management programs in order to better engage in population health and risk management. While there is no perfect solution or one-size-fits-all model for healthcare organizations (HCOs) that explains how to more closely integrate care management with population health management, there are key issues every HCO should consider. Given the rapid pace of change, HCOs must begin reviewing these factors now to determine how to grow the competencies needed for population health management and care management within their organizations over the next 12-24 months or face the risk of being left behind.

Care management in the era of population health can take on a variety of different flavors. Are you focused on the top few percent of patients driving your costs? Are you focused on broadly improving population health for certain disease states? Are you focused on transitions in care and preventing readmissions? Should the structure of care management be centralized for the organization, decentralized into each physician's office, or use a hybrid approach? Answering these questions helps determine the flavor that's best for you.

When thinking about implementing a care management program, I suggest healthcare leaders break it down into two high level components: where do I focus my efforts? And, how do I create programs and structures for success?

While where to focus care management efforts will be different for each organization, the approach identifying and selecting that focus should be the same for all. The key for any population health program is to create an analytics platform that allows to you deeply understand the characteristics of your population and provide your best opportunities to manage it. For example, who are your ED frequent fliers? Who is at-risk to require costly care this year? What patients are not clinically non-compliant with evidence-based care? These answers should be correlated to your payer and organizational contract incentives, goals, and your potential ability to impact outcomes.

In addition, the analytics platform must be able to highlight subtle factors that may be driving results. For example, are access issues driving higher-than-expected ED use? Is physician variability in practice patterns driving unexpected readmissions? While the optimal care management solution for every organization will be unique, a methodical, deliberate analysis of the data is required to help you understand how to best use limited care management resources.

Once you've defined your areas of focus, structured programs should be put in place supported by a strong technology platform. In addition to traditional care management skills, care managers should to be trained for behavioral and motivational interviewing techniques and how to understand the socioeconomic dynamics in your community. Leadership must create an environment that supports multi-disciplinary, creative solutions for unusual problems. The program design should recognize that the physician is not the care manager but needs to be appropriately engaged in the process. The supporting care management technology platform should:

  • Help identify and enroll patients in your programs
  • Offer task management and communication tools
  • Provide evidence-based care plans that guide care managers while allowing flexibility to support individual patient needs and goals
  • Include analytics to help manage productivity and effectiveness of your programs

While it may be tempting to use spreadsheets or local databases to manage your care management program, most organizations quickly learn that the maintenance costs - as well as the risks of not having an enterprise-ready tool to manage this important function - quickly outweighs the benefit. The skills, analytics, and change management needs associated with value-based care and care management are novel to most provider organizations. Download and review the report How Care Management Evolves with Population Management to compare your organization's risk sharing and data analytics initiatives to your health system peers and access insightful takeaways that can help you better define your organization's path.

Andrew Mellin

About the author

Andrew Mellin is a vice president and medical director for Studiomaca, where he currently provides strategic direction for the Population Health & Risk Management group for Studiomaca Connected Care & Analytics. He received his MD from Duke University, completed his residency in internal medicine at Barnes Hospital in St. Louis, received his MBA from the University of Minnesota, and is board certified in Internal Medicine.