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BUSINESS PROFILE
Creating Value with
Effective Care Management
Care management has become a key issue in the
implementation of value based care. What should
healthcare organizations keep in mind as they
manage care?
David Wennberg: A key challenge is having healthcare
organizations rethink what care management and
coordination really are. They may have discharge planners, navigators, or even disease managers on staff,
and in their minds that constitutes care management.
In reality, these roles exist in silos. Staff members
expedite acute care strategies, not improvements
along a care continuum.
Instead, I would define care
management as patient-centric, longitudinal support
that reduces the overuse of undervalued services and
increases the use of effective interventions.
What are the core competencies required for successful
care coordination?
Wennberg: What I would call the generalist model for
care coordination requires three core competencies.
The first competency is having the skill to navigate the
healthcare continuum. Staff need to direct patients to
the appropriate provider and setting for their care. The
second competency is enabling behavior change.
This
means getting individuals engaged in behaviors that
promote long-term health, such as stopping smoking,
controlling blood pressure, and losing weight. The
last competency, which is not as widely understood but
is certainly important, is promoting shared decisionmaking—getting people involved in their healthcare so
they become active participants in making decisions,
respecting their preferences and values. The same care
coordinator can do all three of these functions if he or
she is supported by technology.
What role does technology play in care management,
and what are some of the challenges of using it?
Scott Kolesar: Technology by itself is not sufficient to
drive patient care; however it is absolutely necessary to
facilitate care management across a large population.
In the early days of accountable care, organizations
managed relatively small Medicare populations,
typically fewer than 15,000 patients, where they could
manage them with some payer data and a spreadsheet.
Those days are gone.
Today’s care management requires
a comprehensive data integration solution, which
includes a health information exchange that ingests
and normalizes population health data into a robust
analytics solution that identifies and prioritizes clinically or financially at-risk patients for care manager
intervention. What’s more, the solution must have a
dynamic workflow capability that connects care teams
and helps them work collaboratively to manage the
patient’s care, whether that’s providing chronic or
complex care management; managing care transitions,
monitoring self-care, or assisting with end-of-life.
The system should also curate evidence-based clinical
In this Business Profile, Scott Kolesar, principal and senior leader in Deloitte
Consulting LLP’s Value Based Care practice, and David Wennberg, MD, MPH, adjunct
associate professor of The Dartmouth Institute and former chief executive officer,
Northern New England Accountable Care Collaborative, discuss the challenges and
competencies involved in creating a care management organization.
Kolesar
Wennberg
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content, which can help to standardize care delivery
across the continuum. Unfortunately, such a comprehensive solution is hard to find. There are literally
hundreds of vendor products available that have
many of the capabilities, but no one system does it all.
Instead, healthcare organizations may have to consider
a multi-vendor, best-of-breed solution to meet all their
needs. At Deloitte, we utilize technology and analytics
solutions with a combination of vendor solution and
best practices to provide that holistic approach.
How can effective care management improve outcomes
while reducing costs?
Wennberg: Patient navigation guides the patient to
the most appropriate, cost-effective care setting.
If a
healthcare provider is treating a diabetic patient, and
he or she developed a care coordination strategy and
good relationship with that patient, the patient is more
likely to call the physician or provider first before
heading to the emergency department (ED). This
keeps patients out of the acute care setting, because
you can proactively address issues, assess their symptoms telephonically or direct them to the primary
care setting as opposed to the ER—all of which reduce
costs. Also, self-management—getting patients to
engage in their care for chronic conditions, such as
diabetes or obesity—is the least expensive, and in
many ways the most effective care strategy if you’re
in a risk-based contract.
Kolesar: Technology prioritizes those patients who are
most likely at risk clinically or financially, such as high
care utilizers or those who frequent high-cost sites.
An
automated solution can put these individuals at the top
of a care manager’s to-do list and thereby avoid escalating clinical conditions and related high costs. In addition, care management solutions that embed leading
practices for a particular condition in provider workflow, permit organizations to deliver care with less
variance which has been shown to enhance outcomes
and potentially lower costs.
What are the additional investments healthcare
organizations will have to make to gain core competencies,
and does this mean they should consider outsourcing?
Kolesar: Most care management organizations reside
in entities outside the health system walls, so there
can be significant startup costs required to establish
the enterprise, invest in new technology and human
resources. Return on these investments will be a
number of years away, given that revenue is predicated
on successfully delivering good care, changing
behaviors, achieving improved clinical outcomes and
effectively managing the risk-based arrangement.
By
working with third parties that provide technology and
people solution platforms in an outsourced, subscription,
or per-member-per-month pricing model, organizations can avoid the significant upfront capital outlay.
As healthcare organizations begin to operationalize
care management with the move to value based
payment, what are some insights you can share for
the future?
Wennberg: Organizations will also need to rethink
skillsets and how they will accomplish day-to-day
tasks, as some fairly radical changes are going to
occur in the next 10 years. Everyone from the care
coordinator to the organization’s CFO will have to shift
their thinking. For instance, getting accustomed to
tracking patient health using the telephone, text, or
email, will be challenging for some.
Certain organizations will embrace change while others may accept it
gradually. To be successful long-term, organizations
must think about the competencies of their senior
executives and care management staff as well as their
abilities to enable stronger care management.
Kolesar: Technology will continue to play an everincreasing role in gathering a wider array of data to
both track patient care and alert providers to patient
issues. I’m referring to technology such as fitness wearables and remote medical devices that monitor heart
rate, glucose levels, weight, and so on.
The challenge is
what to do with this information and whether or not to
encourage patients to use such devices. A lot of this data
is not actionable, unless there are sophisticated algorithms and analytics that can take the information and
provide insight either in the form of an updated risk
score, alert, or direct-to-patient communication. At
Deloitte, we leverage analytics platforms to provide
solutions for healthcare organizations facing these
challenges today.
It’s very exciting, innovative work.
Are there any additional materials you recommend for
providers to improve their value based care strategies?
Kolesar: For more on value based care insights and
thought leadership, visit www.deloitte.com/us/vbc
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