Navigating a medical condition can be complex and even daunting for both patients and their caregivers. Care management is gaining traction as a service that can help navigate that process. Care managers — who are typically nurses or social workers — partner with patients and their caregivers, support connected communication from providers to patient and collaborate with patients and caregivers to assess risks and needs, develop care plans and champion self-care.
As an increasingly widespread service, care management can also provide an excellent subfield for aspiring health care management professionals. Service providers will need project administrators and health services managers to run organizations and maintain operations efficiently, integrating care management into existing health systems and maximizing the service’s impact.
The online Master of Business Administration (MBA) in Healthcare Management program from Florida Institute of Technology prepares students to excel in management roles within the health care industry. As such, graduates of this program are ideally suited to successfully lead care management operations.
What Is Patient Care Management and Why Is It Important?
Care management programs focus on managing the health of a defined population through a team-based, patient-centered approach. The purpose is to connect patients and their support systems collaboratively with the purpose of improving quality of care while lowering costs.
While care management provides a benefit to recipients of health services, it may also offer efficiency for the health care system overall. Because a care manager is involved in the overall patient case, they understand the context surrounding each case, and can advise against interventions that may not be an appropriate fit. This direct connection to care equips the care manager to notice changes in conditions before they result in an emergency room visit.
Care Management Examples and Best Practices
Care management professionals can improve their work by following several commonsense principles and practices. Examples include developing cultural competence, advocating for patients, and treating patients with respect and dignity.
Effective care management typically improves care for patients. However, simultaneously reducing costs can be difficult, especially in highly structured — and potentially inefficient — environments like hospitals.
Addressing these challenges is an important task for professionals involved in care management, hospital administration and related areas. To ensure both patients and systems realize the care and cost benefits of care management, the following care management system best practices are critical to success.
Practice face-to-face contact
While a case may determine the degree of face-to-face contact required, in-person appointments or home visits are good practices. Also, care managers should attend hospitalizations and primary care visits to ensure communication between the provider and the patient is clear. In this way, care managers will also receive care updates and instructions firsthand.
Encourage engagement
The care manager should engage in all aspects of the patient’s care and encourage the patient and caregivers to practice the same level of engagement and commitment. Lack of engagement can be a top challenge providers face when working with patients with chronic conditions. To encourage engagement, some plans even offer incentives like gift cards, a lower insurance premium, discounted health club or gym memberships, or a cash payment or bonus when program engagement criteria are met.
Integrate care
Ultimately, the care manager should approach the full group of treating professionals as a team, regardless of whether they are all employed by the same practice. To develop a comprehensive care plan, the care manager will need to collaborate with the patient, caregivers and treating professionals. To understand the patient in context, the care manager will need to integrate claims data, laboratory reports, prescriptions and goals into a comprehensive care management plan. This level of integration can help ensure that nothing slips through the cracks. An established care management plan can be designed with a workflow to eliminate redundancy from providers and the possibility of a responsibility or task going unassigned.
Target patients
High-risk patients with multiple chronic conditions stand to benefit the most from care management. Plus, left untreated, chronic conditions can result in more expensive care, resulting in higher costs for the patient and health care system. Thus, targeting high-risk patients helps care management realize the most cost benefits.
Care management programs need to consider available interventions and program objectives to target and select individuals who would benefit from those interventions and meet objectives. Acute events, like emergency room visits or hospitalizations, are often points to target in care management programs, as they present the opportunity to reduce costs as well as foster patient engagement. Predictive modeling can also help determine target populations by analyzing risks and trends that may indicate patients who would be most successful in a care management program.
Tailor programs to context
As with anything involving people, a one-size-fits-all approach is not best. Instead, care management professionals tailor programs to the context in which they occur. For example, a large, urban practice can offer an in-house practice of care managers, while a small, rural practice may need to establish a network of other independent providers to build a care management team.
In addition to creating programs based on resources, programs must also be tailored to the population they are serving. For example, a care management program supporting elderly patients with chronic conditions may be best led by a nurse, while a care management program supporting at-risk populations adverse to care may be better led by a community health professional or social worker.
At an individual level, programs may also need tailoring for the specific patient. Language, culture, socioeconomic status, religion or other personal attributes can influence the care management program. This can be a dynamic process, as the patient’s needs will evolve through treatment.
Foster self-management
Patients must be active participants in their care management programs, and care managers can support this by fostering self-management. By understanding how willing a patient is to change, as well as what resources they have available to support that change, care managers can help patients set goals, monitor their progress, and take ownership of their medical conditions as well as behaviors that can impact those conditions. Patients should also be encouraged to manage their medications and identify warning signs in their health.
Leverage technology
Advances in technology are helping streamline record keeping and collaboration — even across practitioners and medical practices. Electronic medical records provide immediate access to understand health risks, reduce duplicative efforts, and facilitate communication and feedback between providers.
Further, modern technologies enable remote patient monitoring, which can improve efficiency, minimize costs and help connect patients with the care team more regularly through mobile phone service or automated reminders. Technology can also support patient engagement and self-management.
Focus on the front end
With emergency department volumes on the rise (up roughly 40% from 2020 to 2024), care managers must coordinate the workflow in acute facilities while ensuring nothing is overlooked amidst a fast-paced, often overcrowded environment. Care managers can support efficiency by determining if the ER is the right fit for a patient — or if they would be better suited for observation or an outpatient facility. This discernment can cut costs for the health care facility and ensure a better plan for the patient.
Train personnel
For management and administrators, a plan for training care management personnel is necessary to equip staff with the correct skill set and ensure all positive outcomes of care management can be realized. Care managers and case coordinators must build strong interpersonal skills to communicate with providers, patients and caregivers alike. They should also be prepared to apply a team-based approach to care and willingly integrate with other professionals. Often, this can require a health care workplace culture change, as traditional systems often focus on diseases over patients and providers over a holistic team.
Training around workflow is also imperative for a successful care management practice. Care managers must be able to understand and communicate across disciplines, demonstrate cultural competence with diverse populations, and function as one part of a team.
Evaluate practices and systems regularly
Finally, care management practices must regularly undergo introspection. For example, the care management team must consistently review patient-reported outcomes (PROs) to understand not only health status, but also pain, physical functionality, quality of life and a general picture of the person. After all, care management is ultimately about providing better care for people.
Another important area to examine and minimize is low or no-value care systems. This could be a costlier and more involved treatment that is not shown to provide a better outcome.
Further, to understand efficiency, practices can measure avoidable emergency room visits or sensitive admissions. These should decline with an effective care management program.
Evaluation shouldn’t be punitive in intent. The purpose is to elevate the impact of care management services. The insights gleaned from evaluation should be used to drive process change, eliminate treatments that aren’t working and coach care managers to improve their approach.
Use Care Management Best Practices to Make a Difference
Although dedicating a care manager to support a patient will likely improve the patient experience, care management must be approached intentionally. Through adopting these best practices, health care managers and care management professionals can optimize their impact on patient outcomes and the health care system at large.
Learn more about the online MBA in Healthcare Management program from Florida Institute of Technology.
