Care management is the set of activities that are meant to help patients and improve their process of care by managing the medical conditions with the aim of reducing their need for medical services. These efforts are made to improve the quality and reduce the costs of patients with complex health conditions.

There are certain goals of care management -

  • It focuses on improving coordination of care.
  • Removing duplication of services.
  • Reduces the need for expensive medical services by enhancing the coordination of care.
  • Helping patients and their caregivers or nurses to successfully manage health conditions.

There are 3 key strategies to improve existing or emerging care management services.

  • Identify the population(s) with changeable risks factors (factors on which an individual has control over).
  • Adjust care management services according to the needs of the population(s).
  • Identify, prepare, and involve appropriate caretaker to deliver the needed services.

care management

What are the components of a well-organised care management program?

The care management program is a team-based program organised to focus on the well-being of patients. The program is designed to assist patients and their caretakers or support system in handling the medical conditions of the patient more effectively by reducing the cost of medical treatment.

Conducting care management programs and handling different types of cases effectively can be a challenging task. Below are the components of a well-organised care management program.

  • Data Unification - For example - clinical data, claims or socioeconomic data feeds, etc.
  • Patient Stratification and consumption - For example - stratification, risk, and patient load balancing algorithm, etc.
  • Care Coordination - For example - care plans, assessments, community resources, etc.
  • Patient Engagement - For example - medical and fitness device data, matching patient algorithms, etc.
  • Performance Management - For example - reliable and meaningful outcome, balance, and process management, etc.

How are the patients identified for care management programs?

Care management programs are mostly for those patients who are suffering from various diseases and are in need of care, this program reduces the cost of treatment. The patients with complex health conditions have the highest opportunity to can avail of the benefit of reducing health-care expenses.

For maximising the impact of care management on the basis of both quality and cost level it is important to divide the population into two categories

  1. Those who are suitable for availing the benefits of care management
  2. Those patients who are very sick but not too sick

Modifiable risk factors are those factors which the individuals can control by themselves, minimising the risk will maximise the chances that the person will live a long, healthy and productive life. Health care provider must be able to identify the population at modifiable risk if they are able to manage and provide care in such a way that can help to accomplish the goal of cost-saving, better quality, and intensify the patient experience.

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