Posted in Accountable Care, ACO, Affordable Care Act

Care Management: A Deeper Dive

By Gregg A. Masters, MPH

Earlier I was asked by Lumeris to moderate a webinar on Care Management featuring Deborah Robin, MD, MHCM Medical Director and Eric Mueller, JD, MBA, Director, Product Management. This session is an exploration into the importance and key components of Care Management.

In an earlier post, Dr. Robin notes:

In my role at Lumeris I often get asked by our clients, “What does care management really mean?” For me, having spent decades practicing geriatric medicine and teaching the principles of post-acute care coordination at a private research university and medical center, care management can be defined, most completely, as better care at lower cost for people with multiple health and social needs.

I know firsthand the challenges physicians face in providing quality care to high-risk patients and populations. It is hard to believe that better outcomes can be achieved when nationally, re-admission rates remain close to 24 percent within 30 days of hospital discharge, and nearly 80 percent of these re-admissions are for preventable conditions according to MedPAC.

To achieve better care at lower cost, health systems need to change the way they manage high-risk patients and create an entire care community working together to ensure that each patient receives the right care, in the right place, at the right time.

Though that sounds like a far-off health care utopia, I have worked closely with Lumeris at designing a Care Management solution that achieves what may seem impossible. The results of this solution speak for themselves in the Lumeris-operated 4.5 star-rated* Medicare Advantage Plan where health plan staff, physicians and patients have worked together to reduce 30-day hospital readmissions by nearly 13 percent in 2012.

This Care Management solution supports multiple workflows in the coordination of care for high-risk patients and high-risk events. Technology, education and strategy support the health care team in their ability to effectively stratify, engage and manage high-risk patients and populations to prevent adverse health outcomes, while managing cost and delivering optimal patient care.

The complete and original post by Dr. Robin is available here.

[Disclosure: A fee was paid to moderate this session].

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