How to Implement Care Management in Healthcare Systems

You’ve studied up on all the latest treatments, stocked your lab, and refined your front office procedures—but have you and your healthcare providers looked into the benefits of Care Management?

Care Management is team-based care delivery that centers around patients—their specific conditions, circumstances, and demographics—to make their care and your costs more effective and efficient.

Studies cited in the Annals of Family Medicine have demonstrated that this approach works. Appropriate, timely interventions in a specific patient population can reduce health risks and promote better health, while decreasing costs for healthcare systems. How? Let’s break it down.

What Care Management looks like in healthcare systems

Whether you’re a primary care physician or a specialist, you can promote better health by eliminating care that does not improve clinical outcomes—or that your patients simply don’t want.

The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely® campaign to help providers and patients select and schedule only the tests, procedures, and prescriptions that are: evidence-based, non-duplicative, necessary, and pose the least amount of risk to the patient’s body or mind.

Once providers and patients have made these decisions together, care managers adjust healthcare services to better support their patients by:

  • Scheduling appointments
  • Coordinating care requirements
  • Promoting healthy behaviors
  • Providing clear and simple education materials
  • Reaching out to help people stay on track with their care plan
  • Adjusting the plan when needed (as conditions worsen or improve)

Access to care and successful Care Management empowers patients to manage their healing journey and enjoy healthier lifestyles. The sooner conditions improve, the sooner your organization can expect to achieve its business goals—and the sooner healthcare spending can begin to decrease.

How Care Management benefits healthcare systems

Is it possible to continually maintain a high quality of care for your patients while reducing costs for your organization? That’s the question author, Paul Elwood, asked when he developed the Care Management EffectivenessTM (CME) Model, which integrates care management into the processes of both healthcare systems and insurance companies.

Care Management encourages you to:

  • Embrace all innovations that impact your care delivery.
  • Minimize potentially avoidable procedures.
  • Select the right provider, for the right patient care, at the right time, in the treatment journey.

When all of your departments—disease management, complex case intervention, pre-certification, discharge planning, and utilization review—are aligned and communicating regularly, patients tend to enjoy better health outcomes.

How to implement Care Management across a healthcare system

The high-quality healthcare systems that have successfully managed care to improve health outcomes and reduce costs over the last few decades have systematically followed these steps:

1. Assess needs

It’s important for all clinicians on your team to understand the critical needs of your practice. What measures can improve their daily processes? What tools are needed to improve healthcare services and health outcomes most effectively? What steps can be implemented to prevent clinician burnout?

A recent study published by the National Taskforce for Humanity in Healthcare found that hospital physician burnout costs the U.S. healthcare industry $1.7 billion each year. Across all U.S. physicians, the cost of burnout is closer to $17 billion. Determine what your team needs to prevent burnout-driven turnover, productivity reduction, and patient satisfaction lags.

You may determine that you need to prioritize certain specialty care procedures and de-prioritize others. Research has repeatedly shown that high intensity, high-cost treatments do not always lead to better disease control or health outcomes.

For example, patients who undergo expensive spinal fusion for back pain don’t always have better outcomes or more satisfaction than those who choose physical therapy and lifestyle changes. Expenditure does not necessarily translate into better health outcomes. Determine which high-quality healthcare services and processes your organization needs in order to add more value.

2. Establish goals

Once your needs are clear to all, determine which patient satisfaction and cost-cutting goals to set and why. Are you aiming for a certain number of positive reviews, referrals, and repeat patients? Are you trying to meet the reimbursement payment requirements of a regulatory program like Chronic Care Management (CCM)? Meeting a cross-organizational budget cut benchmark set by your executives? Defining your “why” helps you structure your financial goals more effectively to forge optimal healthcare systems.

When your entire organization has enthusiastically agreed upon a set of goals, it will be easier for you to decide what areas in your current healthcare system need to adapt, and which healthcare providers need to pivot in order to achieve those goals.

3. Identify patient population

Once you’ve established the goals and the reasons behind your Care Management program, identify your target patient population. Take a look at the data your healthcare system has collected over the years of serving patients to find a population that could benefit the most from care management.

Once you’ve determined your target population, you can assess its needs and identify which patient care to include in your program. Does the target population need coaching? Do they need help finding transportation to appointments or guidance on how to navigate care delivery?

After you’ve discovered their needs, you can build a Care Management program that helps them lower costs and improve their health outcomes.

4. Engage internal stakeholders

Once you or your team leader have established and shared program goals and identified your target population, you can determine which stakeholders are required for which healthcare services.

Your team’s registered nurses will need to communicate with a wide range of specialty care teams to make holistic clinical care decisions. Those decisions then have to be shared with health navigators who can reach out to help engage each patient based on personalized needs, attitudes, ages, genetics, condition stages, and environments.

5. Implement necessary technology and integrations

Technology can help make all this high-quality, outcome-enabling communication much easier and more effective. Patient Relationship Management (PRM) software allows your entire team to track patient care and engagement—helping you, in turn, to strategize how to best reach out to them.

Is your patient more responsive to phone calls? Texts? Emails? Maybe they’re used to healthcare systems that offer secure messaging on a particular portal. Perhaps video conferencing will fuel their connection with you. Telemedicine has enabled medical attention for a large population of people who simply cannot travel to meet with a doctor in an office as often as they’d like.

When all touchpoints and data—pharmacy instructions, social health determinants, medical history, and health outcomes—are visible to all team members, the right decision is more likely to be made, at the right time, every time.

Remote patient monitoring devices like blood pressure cuffs, scales, and glucose monitors also allow patients to take greater control of their own health data and care delivery. The right tools can improve your continuum of care and engage your patients more than short, in-office visits alone. They can also help keep your patients’ healthcare costs from mushrooming.

6. Educate patients and staff

Patients can’t follow care plans they don’t understand. And each patient has a different level of literacy, education, or attention. Make sure you explain healthcare policy, protocols, and processes—demonstrate care management tools on their level.

For some patients, a how-to guide will suffice—others will need to watch a video or attend a class to learn how to follow a protocol or use a device. Patients who are being monitored remotely should demonstrate, in your presence, the ability to use their device or app to measure their progress and communicate health outcomes to your team.

More inquisitive patients may want to discuss health statistics, case studies, or clinical trials—be prepared to do so. Make sure they understand you’re not reinventing the wheel with this management initiative—reassure them that it’s been proven in many cases similar to theirs.

More socially active patients may find comfort in joining an online community where they can discuss their healing journey—disease control, health data, and emotional responses—with others who’ve been through it. Be prepared to suggest one.

7. Measure results

Successful clinicians achieve successful health outcomes by constantly monitoring, measuring, and adjusting health policy and treatment plans. Technology can help your organization track how many targeted patient populations are engaged and following your protocols. It can also help you monitor health information and patient satisfaction ratings.

Once you begin measuring your workflow, you’ll be able to determine the direct impacts of your efforts (like healthcare costs and health outcomes) as well as indirect impacts (like increased market share and customer loyalty).

Implement Care Management within your healthcare system today

In today’s healthcare landscape, you’re not always compensated for how many tests or services you perform or order. Instead, you’re rewarded for providing individualized, quality care and positive health outcomes—while cutting healthcare costs, wherever possible. Implementing Care Management in your healthcare systems will help you accomplish these goals.

Help both keep your patients and your practice healthy for the long-term. Download our guide to Value-Based Care and let us know how your outcomes improve!

Sign up to receive Welkin updates, delivered straight to your inbox

    This site is protected by reCAPTCHA. Google’s privacy policy and terms of service apply.

    Related Articles

    4 Hard Questions Healthcare Providers Should Ask Technologists

    Tough questions are good -- and healthcare providers and technology decision makers should ask more of them. That’s particularly urgent right now since healthcare providers are relying on technology more than ever.  The next few weeks and...Read More >

    EMRs Contribute to Physician Burnout - But Better Technology Could Help

    Physician burnout was an acknowledged problem long before the pandemic hit.  But now doctors who were previously burdened with lack of autonomy and pressure to pack their days with too many patients are now grappling with the...Read More >

    What Your Care Team Needs to Know About Patient Management Software

    Patients are demanding more from healthcare professionals today. They want high-quality, whole-person care and the assurance that their doctors and nurses are really there for them. Insisting on better quality of service and improved outcomes puts pressure...Read More >