What is Care Management?

I recently joined the advisory board of Arcadia Healthcare Solutions, a leading provider of analytics, decision support, and workflow enhancement services.   At my first advisory board meeting there was a rich debate about the marketplace for care management and population health tools.   I’ve spent years studying such solutions at HIMSS and found most of the products are “compiled in Powerpoint”, which is a very agile programming language, since it’s so easy to change…

At BIDMC, we think of care management as two things
*identifying a cohort of patients based on analysis of financial and clinical data
*creating and tracking an action plan for that cohort

We built those core components into our self developed EHR some years ago.   The tools are in very active use to reduce readmissions and improve quality using disease specific protocols.

Other care management services are very important, but we are happy to delegate development of such tools to third party cloud and mobile providers.  Such items include customer relationship management applications supporting case managers, patient facing health coaching, secure patient/family/caregiver groupware, self management resources, and chat/tele-visits.

In my experience, the hardest aspect of care management is unifying financial and clinical data from multiple heterogenous sources, linking the right patient records together, and curating the data to improve data quality.   Once such a foundation is available, then tools for analytics and data visualization can be added on top.  

Most clinicians know they need care management and population health tools, but they are not sure what they need, what questions to ask, and what techniques should be used to turn the data into wisdom, such as risk adjustment.

The Trump administration has signaled its desire to reform Medicare.   Tom Price, nominee for HHS Secretary, has noted that the EHRs are burdensome and quality measures are often misaligned with practice workflows.  Medicaid is likely to be more tightly coupled with local care delivery strategies at the state level.

Despite all these changes, the notion of paying for quality and outcomes instead of quantity will move forward.   The only way to succeed in a value-based purchasing world is to embrace care management techniques that can keep patients healthy in their homes, reducing total medical expense, improving wellness, and enhancing patient satisfaction.  

My advice to Arcadia and to the industry
1.  “it’s the data”,  not a killer mobile app that needs to be the top 2017 priority.   Once the longitudinal community-wide clinical and financial data is collected and cleansed, the rest will follow.    Arcadia has unique expertise in data science, as demonstrated by its high KLAS ratings.
2.  Don’t introduce too many different disparate innovations into clinician workflows simultaneously.  
3.  Spread the care management activity across teams of staff, each practicing at the top of their license - doctors, nurses, case managers, pharmacists, and family caregivers.   Minimize data entry burden.
4.  Partner with other companies and organizations which offer complementary mobile application services
5.  Become a value-added contributor to the EHR ecosystem, not a competitor to EHR vendors.   Although EHR vendors will offer basic population health within their products, no single EHR vendor can combine data across all the sites of care visited by a patient, so third party care management tools will always be important.

I hope this provides a logical roadmap for the care management work ahead and enables you to validate that the organizations promising care management products and services can really deliver them.