Care Management Platforms: Supporting Value-Based Care Delivery

Hospitals and medical practices are getting hammered by value-based contracts. You get paid for keeping patients healthy, not just treating them when they're sick. Care Management Platform systems help you track patients between visits, spot problems early, and coordinate care across your entire network.

Most practices still work the old way. Patients show up sick, you treat them, and they leave. That doesn't work when Medicare and insurance companies dock your payments for readmissions and poor outcomes.

What is Care Management?

Care Management is actually keeping track of your patients when they're not in your clinic. You monitor their medications, make sure they follow up with specialists, and catch problems before they land in the emergency room.

Here's what care managers actually do:

• Check on high-risk patients between appointments
• Make sure patients actually take their pills
• Set up appointments with cardiologists and endocrinologists
• Help patients deal with Medicare paperwork and find food banks
• Call patients after hospital discharge to prevent complications

How Do Care Management Platforms Work?

Care Management Platform software pulls information from your EHR, billing system, and lab results to create a complete picture of each patient. Also, it flags patients who missed appointments, haven't filled prescriptions, or have gotten abnormal test results.

The system sends alerts when patients need attention. Maybe someone's blood sugar is running high, or a heart failure patient gained five pounds in three days. Your care manager gets notified and can intervene before things get worse.

Why Healthcare Organizations Need Care Management Solutions?

Care Management Solution technology fixes the biggest problems in value-based care. You can't manage what you can't see, and most practices have no idea what happens to patients between visits.

Without these systems, patients slip through cracks:

• Diabetics stop checking their blood sugar and end up hospitalized
• Heart patients don't weigh themselves daily and go into fluid overload
• Mental health patients stop taking medications and relapse
• Post-surgical patients develop infections that could have been prevented
• Elderly patients fall because no one checked on their home safety

Key Features of Effective Care Management Platforms

Care Management Platform systems need certain features to actually help your practice succeed in value-based care.

What you actually need:

• Risk Scoring: Which patients are going to cost you the most money? The system spots them based on how sick they are and what's happened before.
• Task Management: Your care manager calls 50 patients a week. She needs a way to remember who she called, what they said, and when to call back.
• Patient Communication: Patients call the front desk about everything. Give them another way to ask questions so your staff can do other work.
• Outcome Tracking: Show me which diabetics are hitting their targets and which ones are heading for kidney failure. Show me if I'm making or losing money on my Medicare contracts.

Who Benefits Most from Care Management Solutions?

Care Management Solution platforms work best for practices with lots of Medicare patients or those in ACO contracts. If you're getting paid based on patient outcomes rather than visit volume, you need these tools.

Family doctors get hit hardest because they're supposed to manage everything their patients have wrong with them. Hospitals want to stop patients from coming back within 30 days because Medicare won't pay for it.

If you treat lots of diabetics, heart patients, or people with breathing problems, you need this. These patients call constantly and show up in the ER when things go bad. Community health centers deal with patients who can't afford medications or don't have transportation to appointments.

Measuring Success with Care Management Platforms

The success? It's fewer emergency room visits, fewer hospital readmissions, and patients who actually take their medications and show up for appointments.

Track these numbers:

• Patient Outcomes: Are your diabetics keeping their A1C under control? Are your heart failure patients staying out of the hospital? Are patients filling their prescriptions?
• Financial Results: Are you meeting your quality benchmarks? Are you getting bonus payments from Medicare Advantage plans? Are you avoiding readmission penalties?
• Staff Productivity: How many patients can each care manager handle effectively? Are patients responding to outreach attempts? Are care plans getting completed?

Takeaway 

Value-based care isn't going away. Practices that figure out how to manage patients between visits will succeed. Those who don't will lose money on every Medicare and insurance contract. Care management platforms give you the tools to track patients, prevent problems, and prove you're delivering quality care.

Persivia offers platforms that help practices track high-risk patients and coordinate care across your entire network. Our tools work with your existing systems to reduce readmissions and improve quality scores.