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Care Management

What Is Care Management?

Care Management is the set of collective activities designed to improve patient care and teach patients how to manage their health conditions more effectively. Care Management reduces the need for medical services and improves health outcomes. Care Management programs enhance the coordination of care, eliminate duplication, and help patients improve their quality of life. 

The benefits of Care Management

Care Management is used to understand a patient’s health conditions and desired outcomes in order to teach them how to self-manage their symptoms. Armed with this knowledge, care managers can help patients realize many health benefits. 

Here are some of the benefits you could see for patients after implementing a management program to better the care delivered at your healthcare organization.

Improved quality of care

With Care Management, patients attend preventative and primary care visits more frequently thanks to provider intervention. The right program will enable a strong relationship between providers and patients, and encourage more frequent touchpoints and communication.

Providers can help their patients achieve improved health outcomes over the long term by closely monitoring their health. Gradual, positive changes to the patient’s habits and health will result in increased longevity and provide a better overall quality of life. While the results may not be immediate, healthcare organizations with Care Management programs consistently see improved clinical outcomes over time. 

Increased patient satisfaction

When they feel they are truly being taken care of, patients perceive that they are receiving a higher quality of care. And when patients sincerely believe they can trust their care team to monitor their health, patient satisfaction may also increase. 

It is a care manager’s job to understand each patient’s health history and any and all external factors that may be impacting their health—for better or worse. To gain this valuable information, care managers must build a trusting relationship with their patients and practice exceptional patient communication skills. When a patient feels their clinician is genuinely listening to their concerns, they will feel more satisfied in the patient-provider relationship.

Reduced indirect costs

While cost reductions are not often seen directly nor right away with Care Management programs, many indirect costs can be attributed to adding care managers to a care team. To see both clinical and financial success, healthcare organizations must carefully consider which patients would benefit the most from working with a care manager. 

For example, management programs that target patients’ transitions from hospital to home see reduced hospital readmissions. These care programs ultimately lead to lowered costs, as readmissions increase operational costs for healthcare facilities. 

Care Management programs can also reduce the use of high-cost acute care services, as well as the number of duplicative tests and procedures that can likely occur when a patient sees many care teams with different specialties. 

Increased patient reach

An effective Care Management program can help your healthcare organization reduce administrative tasks and streamline care. Not only can you increase meaningful patient engagements, but also free up your time to support an increased number of patients overall. With all of this extra time, you can more easily scale your organization and increase your patient reach exponentially.

What’s the difference between Care Management and case management?

While Care Management and case management are often used interchangeably, there are some key differences between the two. 

Care Management

The goal here is to ensure patients are getting holistic, patient-centered care that focuses on all aspects of their health. A care manager’s job is to fully understand the underlying dynamics of their patient’s health, including social aspects—such as their relationships with family members and friends. Through this deep understanding of their patient, care managers can best advocate for their patients to make sure they are getting the optimal treatments from providers, and maximum benefits from insurers. 

Case management

The ultimate goal of case management is to improve the patient’s health. However, case managers are often employed by agencies or insurers—such as Medicaid and Medicare—which means they are also focused on cost-effectiveness. 

Typically, case managers help patients navigate a specific disease, condition, or circumstance. Their employer defines their scope of work and requires them to evaluate the financial effect of the patient’s care on stakeholders, such as insurers. A big part of a case manager’s job is to eliminate noncompliance and overutilization. In other words, their job is to make sure the patient is getting what they need—within reason.

What makes a Care Management program successful?

By nature, Care Management can be a high expense. To ensure that your program is cost-effective and successful, implement these key elements:

  • Patient engagement Engaging not only patients but their families and other members of their support systems, as well, is vital to the success of your Care Management program. Patients should feel like an integral part of the care team and have a say in the decision-making process. Patients that are activated in their care are more likely to see improved clinical outcomes. 
  • Training Care managers should be properly trained to provide holistic, patient-centered care. This includes learning valuable skills that will help the patient reach improved health outcomes, such as efficient patient-provider communication and how to activate patients in their care. 
  • Support system Patients with complex conditions or illnesses, particularly those that take a heavy toll emotionally and mentally, require a strong support system made up of an excellent care team and loved ones. Beyond care providers, a support system can include spouses, children, parents, friends, and any other individual that is capable of supporting the patient through their health journey when they are home, away from their care team. 


How can Care Management be used to improve health outcomes?

While Care Management can be helpful in many different health circumstances and clinical settings, it is essential to manage and monitor patients with mental and behavioral health conditions. For these patients, holistic care is vital to their health, well-being, and happiness. 

With mental healthcare management, clinicians can ensure that patients’ physical, mental, emotional, and social needs are met so they are able to lead full, happy lives—in spite of their mental health challenges. Healthcare organizations can analyze different populations and their unique mental health disorders to determine where their patients might need extra support. 

The same principles can be applied to behavioral health disorders, like drug addiction. With a multifaceted behavioral health condition such as this, whole-person care is crucial for healthcare providers to get to the root of the problem, which tends to go much deeper than symptoms (e.g., the addiction itself). Proper, more complete management of care can provide the structure that patients and clinicians need to properly treat complex health issues. 

The same concept can be applied to any patient that has comorbidities, especially those with mental health disorders or challenges. Patients with chronic conditions generally have a higher risk of developing depression, anxiety, and other mental health disorders due to the mental toll of being sick all the time. With Care Management, all symptoms are addressed—not just the physical ones. 

What is Care Management software?

Value-based care reimbursement models are replacing outdated traditional care delivery. With the shift to patient-centered, holistic care well underway, healthcare organizations need a way to organize the many aspects of care delivery. With a Care Management software that is designed to support the value-based care model, clinicians are one step closer to seamless, whole-person care. 

Care Management programs can help with everything from streamlining patient-provider communication and engaging patients, to addressing the social determinants of health and providing touchpoints in between appointments. With the help of a little cutting-edge technology, the shift to value-based care is better for both patients and providers—and overall, your healthcare organization’s bottom line. 

These types of programs are, at their core, patient-centric, so implementing one is a great step toward improving the patient experience. To learn more ways to improve the patient experience at your healthcare organization, download our ebook How to Create Amazing Patient Experiences.