The care-delivery landscape in the United States is evolving. Amazon, CVS, Walgreens, and Walmart are responding to changing patients’ preferences by building consumer-centric healthcare delivery platforms. New entrants, including risk-taking primary-care providers and specialist groups, as well as digital health companies, are expanding their presence and influence. To complete in this consumer-centric value-based world, incumbent healthcare organizations and payers must build new competencies in data, advanced analytics, and workflows to reach the right members, support their needs 24/7, improve their health outcomes, and lower the total cost of care. They need a modern approach to care management.
The modern care management solution empowers the care management staff to deliver preventative whole-person care instead of traditional disease management; helps them in providing continuous day-to-day support rather than episodic monthly visits; provides them tools to connect with their members/patients synchronously and asynchronously via multiple channels, and enables them to create personalized solutions to address each member’s specific needs.
If you are interested in a data-driven, measurement-based approach to care management, here are the top five capabilities you should look for:
1. Predictive analytics for effective targeting
Care management is now important for many more individuals than the usual high-risk, high-touch members/patients, and given the limited care staff, effective targeting is the key. Predictive analytics and insights can significantly improve the design and implementation of your care management programs by helping you identify the patients with the highest probability of potentially avoidable medical costs, rather than simply observing current high costs once a quarter. It can help you achieve the full potential of care management—including a positive ROI, by substantially improving your ability to identify sources of value —for example, avoiding complications, choosing the right setting of care, or shifting care to high-performing providers.
2. Data integration to deliver whole-person care
Your ability to deliver whole-person care is dependent upon knowing each patient’s specific needs and having the ability to connect them to the right resources that address those needs. The digital care management solution provides the data integration capabilities to create a longitudinal patient record – a single patient record comprised of data from numerous data sources across the healthcare continuum. Timely access to the right data is critical to get the full picture of each patient and come up with the right plan of care. The data integration is also important to create an ecosystem of partners and integrate with them, so you know if the patient indeed visited the lab for the order you placed, and you have the results available to you to decide the next course of action.
3. Digital tools for an always-on, connected experience
It is impractical to assume that the traditional approach of monthly phone visits is going to work anymore. The secret to better outcomes is member engagement and if you are calling them once a month, they are not going to be very engaged hence these one-sided programs don’t work. The digital care management solution uses a mobile platform as a scalable and intimate channel to transform this episodic care into a more connected daily support model. This enables care managers to stay connected with many more members and build much stronger relationships with them. The care managers are able to develop highly personalized care plans that address both physical, mental, and social needs – using the biopsychosocial model. These care plans are delivered directly to patients’ phones, giving them simple interactive guidance every single day, to help them along the way and get back to life.
4. Remote monitoring to intervene at the right time
The digital care management solution provides remote monitoring – that helps your teams learn what their members’ new needs are, and what they are struggling with, so they can respond to these evolving needs faster, communicate with them via a secure channel, and change the care plan if necessary. The goal is to make each member feel connected and cared for, on a day-to-day basis. They should feel like their care manager is with them every day, giving them guidance and helping them achieve their personal goals.
5. Collaboration with all stakeholders to deliver interdisciplinary care
High-risk, high-cost patients often have multiple, chronic, and more complex conditions. Unlike multidisciplinary care where each provider is working independently to create a plan specific to their discipline, interdisciplinary teams are made up of various disciplines working collaboratively toward a common goal for the patient. This approach lowers the chance of duplicate assessments, reduces hospital stays, and helps create more complete records of care, all of which combine to better health outcomes. The digital care management solution provides collaborative tools to deliver interdisciplinary care. The providers share the common care plan, see each other’s notes, and can have interdisciplinary group calls with the members when needed.
Sprite Health’s digital care management solution uses predictive analytics to help you identify the right members to target. It seamlessly connects your care managers with members using chat/video and voice via a mobile app/desktop in real-time. Through the use of clinical AI applied to claims, labs, vitals, and social determinants of health, gaps in care are automatically identified and members are engaged. Members receive a daily action plan for diet, exercise, medication, and more. They receive automated behavioral nudges directed to their mobile app to stay engaged and chat or schedule an appointment with their care manager. The remote monitoring tools alert care managers when readings are abnormal. Care managers use a powerful care management platform to create personalized care plans, collaborate with all stakeholders, document encounters, and respond to their members’ changing needs using chat or video calls.