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Bridging the care-management gap

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Joe McDonald, co-founder of Epharmix, writes in Med City News:

“{S}uccess for health systems will require a recognition on their part that a gap exists between population health and current care management. And in the efforts taken to narrow that divide.

“In an Advisory Board study, experts analyzed a modeled capitated Medicare contract in which 5 percent of patients were high-risk, 20 percent were rising-risk, and the other 75 percent were moderate- to low-risk. The study calculated that if no care management were used on these patients, the organization would suffer a negative 8 percent margin.

”Solid care management — particularly for the highest-risk patients — helps mitigate some of that profit-loss equation. According to the Advisory Board model, hiring a care-management team to focus on the top 5 percent of the panel will slightly improve the margin, but the organization will still be in the red with a negative 3 to 4 percent margin. It makes sense that most groups focus their initial care-management efforts on the high-risk patients because it’s the most concentrated group of high-cost individuals. However, there’s still a gap.

Among Mr. McDonald’s suggestions for bridging it:

Invest in tools and management: The first step is to invest in a risk- stratification tool and begin to build a centralized care-management team. As more dollars become at-risk and based on performance, a care manager’s role and importance will continue to expand.

“Expand your focus to rising-risk patients: Focus on expanding your care- management efforts to include rising-risk and high-risk patients — the top 25 percent of your panel. Including patients who are rising-risk makes your strategy more proactive than reactive, and as the Advisory Board’s study pointed out, it’s this strategy that creates a positive margin.’’

“Invest in remote patient-monitoring: Use a remote patient-monitoring solution to automate repetitive care-management tasks. This is especially useful for expanding your focus to the rising-risk population. The real-time monitoring insight enables care managers to operate at the top of their respective licenses and make the most significant impact instead of wasting time cold-calling patients.’’

To read Mr. McDonald’s piece, please hit this link.

To read the Advisory Board report, please hit this link.


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