5 care management findings you should know
Value-based care is here to stay. Organizations that succeed will be the ones delivering care management effectively – making sure every patient has a coordinated plan of care when leaving the hospital.
After several years of evaluating risk-based arrangements, the industry is seeing what works, and what doesn’t. What does the evidence tell us? Here are five key findings that can help guide care management success:
1) Where there is variation, there is opportunity.
The New England Journal of Medicine reported that geographic variation in Medicare spending is primarily due to post-acute care. That, coupled with the fact that there has been a 90% increase in per capital post-acute care spending since 2000, attracts increased attention on how we can improve.
Looking at variation – in quality, satisfaction, cost and other factors – can be the first step in identifying opportunities for improving care management outcomes. Clinical and financial results are closely linked; when you effectively control variation in one area, you will likely see improvements in both.
2) If you just focus on the sickest patients, you’ll still lose money.
The highest risk patients comprise only 5% of the population and almost half of the nation’s healthcare costs. It seems logical to focus care management efforts here first.
But Advisory Board researchers predict that focusing on only high-risk patients will net the organization a negative 3-4% margin in five years. Costs for this group decrease, but the unmanaged rising-risk patients will get worse and threaten financial stability.
3) You’re more likely to earn money when you manage care for rising-risk patients.
Advisory Board researchers also modeled an approach where the health system managed care for rising-risk patients, which comprise 20% of the population. Without intervention, these people will become high-risk patients.
Focusing care management strategies here can reduce the number of people converting from rising-risk to high-risk from 18% to 12%. This significantly improves the financial picture, netting the organization a positive 3-4% margin in five years.
4) When primary care helps manage transitions, readmission rates drop.
Patients are vulnerable when they head home from the hospital. Improving care coordination at discharge can make a big difference. One study found that patient-centered transitions cut the hospital readmission rate by more than half, from 17.9% to 8.0%.
5) Real-time communication remains the biggest challenge for care transitions.
The best way to improve transitions of care, according to NEJM Catalyst survey respondents, is to improve real-time communication among care settings. Clearly defining the roles and responsibilities of clinicians across the continuum helps them operate as a cohesive team.
Download a free, fact-filled infographic and be in the know, with eye-opening statistics on transitions of care that you can use to make a difference today.