INTELLIGENCE IN ACTION

Helping Care Managers Bring Members and Providers Closer Together

Think of care management as a bridge between care teams and their patients—one that’s built upon an unspoken agreement that vulnerability will be met with expertise. The risk of a missed connection is real. But when successful, it’s one of the most powerful and effective ways that health plans can empower providers to deliver great care. These are the encounters that boost member satisfaction, build trust and create a sense of safety—an especially critical element for people with complex and chronic conditions with multiple providers and care locations in play.

Effective care management isn’t merely a series of events. It’s a seamlessly connected and fully informed experience. It sends the message that members can count on their health plan in their time of need.

During a recent webinar hosted by AHIP, Fathom Consulting’s Kat Jayne, Lead Consultant for Experience Research and Design, joined Andrew Mellin, MD, Vice President and Chief Medical Officer at Surescripts, to discuss how health IT can better support care managers and control costs by evolving clinical and medication history data.

When Mellin polled webinar participants, they answered “yes” to the need for:

  • Timely access to hospital admission/ER data
  • Interoperable electronic health record (EHR) data
  • Full medication list including cash-pay and over-the-counter medications
  • Real-time health monitoring data (steps, glucose, blood pressure)
  • Created and missed specialist appointments
  • Behavioral health assessments and notes.

Three Quick Takes: Care Management Challenges

Synthesizing disparate care encounters and clinical data is no easy task. According to a medical director of a large New England-based health plan, “care managers probably spend about 20 minutes gathering data before calling a member. If they call five members per day, that’s 100 minutes of data gathering–so maybe 25% of their time is spent on that alone. Adding efficiencies would allow them to reach more members and improve care.” The key is to empower care managers from the very beginning. Without access to clinical and medication history information, they must analyze the care journey not knowing that whole pieces could be missing. And members can sense the disconnect, whether it’s when they have to fill in the blanks for their care provider whom they expect to have their information, or when they fall victim to an adverse drug event because a prescriber made a decision without the benefit of timely and complete information in their workflow.

Watch this: Effective care management requires the full story.

Healthcare entities with the richest information often lack the resources to share it or have yet to understand the value to the entire healthcare ecosystem in doing so. And even when information does make it from one care provider to another, it often doesn’t arrive in a format that can be quickly used to help members.

Watch this: Siloed information too often means care decisions are made in a vacuum.

Imagine a world where both clinicians and care managers have the patient data they need when they need it, whether at admit, discharge or routine follow ups. It flows seamlessly and intuitively into the workflows of everyone who cares for a that patient—everyone whose role depends on knowing what’s happening as it’s happening. Care managers are instantly informed and can actually support that patient through a potentially life-altering medical event or prevent one by ensuring well-informed discharges, follow ups and chronic care management.

Watch this: Can we take members from an unexpected care event to a smooth care transition?

Care Managers Are Ready for Change

  1. Program leaders are looking beyond clinical data.

    There is a desire to more holistically understand members, and social determinants of health are important.

  2. The lines of communication could be clearer.

    Care management programs are designed to encourage members to work towards what’s most important and impactful. But members often miscommunicate what their providers recommend.

  3. Care managers spend a lot of time on the phone.

    In order to discover barriers, care managers often opt to call members to assess the situation rather than attempt to piece together clinical details or medical history.

  4. Operating at a disadvantage is the norm.

    Forced to work with incomplete and siloed information, most care managers routinely contend with limited, scattered and inconsistent information about the members they’re assigned to help.

While opportunities still exist to improve interoperability in healthcare, we have come so far. And we can make such a difference when we establish trust and build relationships—things that can make a real difference to members. Informing all players on the care team means everyone is more effective in helping that patient achieve their health goals.

Watch the full webinar and visit Intelligence in Action to see how bringing patient insights into focus makes it possible.

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