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What Is The Definition Of Care Management?

Apr 20

According to the Centers for Disease Control and Prevention, chronic physical and mental health disorders account for 90% of the $3.3 trillion spent on healthcare in the United States each year. Appropriate care management may assist healthcare companies in reducing costs while also enhancing the quality and efficiency of care.


Care Management Is Defined As

Care management is a broad term that encompasses a variety of services and activities aimed at assisting individuals with chronic or complicated illnesses in managing their health. The ultimate purpose of care management is to promote patient health. The concept also intends to enhance care coordination, minimize hospital visits, and increase patient participation in order to get there. Healthcare providers can use care management system to help them achieve their objectives.

Comprehensive care management necessitates collaboration. To assist patients take charge of their complicated health requirements, physicians, clinicians, patients, and their carers must all collaborate.

Some or all of the following are components of a care management program:

  • A devoted team of caregivers
  • A comprehensive health-care strategy
  • Tools for medication and care management
  • A service that takes patients from the hospital to their homes
  • Materials for patient education
  • Patients and healthcare providers are able to communicate more effectively
  • Coordination of services with community and home-based providers

The following are some of the most common advantages of care management:

  • Clinical results have improved
  • Reduction in the usage of high-priced acute care services
  • More visits to primary and/or preventive care
  • There are fewer tests and processes that are duplicated
  • Patient satisfaction is higher


A Comprehensive Care Management System's Components

Care management in healthcare is, at its most basic level, a logical extension of primary care. A complete care management program, on the other hand, necessitates a complex coordinated interaction among all healthcare stakeholders, from practices, health systems, and care teams to caregivers, patients, and their communities, to make that ideal a reality.

The following elements are required to start a care management program:

  • Resources available in the community Collaborate with local community organizations to create interventions that address patient care gaps. Encourage patients to take part in community health initiatives that can help them manage or improve their condition.
  • Care that is focused on value. Comprehensive care management fits well within a value-based care paradigm since it focuses on improving outcomes and minimizing total healthcare expenditures. Care management services can be billed to the Centers for Medicare & Medicaid Services (CMS) by healthcare organizations and certain providers who use this model. Chronic Care Management is the name given to this program by CMS (CCM). [Note: CCM services can be billed by qualified healthcare practitioners who participate in fee-for-service Medicare programs. The CCM program, as well as CCM service codes, are covered in depth in this CMS reference.]
  • Coordination of care. Organize specialized care teams for patients with chronic and complicated diseases that communicate and coordinate on patient evaluations, therapy, interventions, and care planning on a regular basis. Each member of the care team should have a clear understanding of their responsibilities. This degree of care coordination necessitates the development of systems and strategies to eliminate duplication of services.
  • Data collection, analysis, and integration are all part of the process. Take data from patients' electronic health records (EHRs), claims data, and other sources and combine it. Use analytics tools to go through relevant data to find patients who would benefit the most from care management, such as those with chronic conditions or those who are high-risk, high-use.
  • Support for making decisions. Educate doctors, clinicians, and employees on how to discuss the program with patients. To improve communication with patients and team members, use visual aids. Posting rules in exam rooms, for example, or giving team members with assessment forms to assist their decision-making, as well as flowcharts and checklists to help them implement the program efficiently are examples.
  • Patient participation and self-management are important. Develop techniques to encourage patients to take an active role in the program by giving them tools to assist them manage their chronic illnesses. An insulin vial tracking journal, at-home blood pressure monitoring, or a healthy cooking class are examples of such equipment. Regular communication with patients should also be a part of patient engagement, whether it's through secure patient portals or SMS reminders.
  • According to a research published in JAMA Internal Medicine, SMS messaging can enhance patient medication adherence by 17.8%.
  • Measuring performance. Implement technology and processes to track the performance of the care team as well as the health of the patients. For example, how much have A1C readings improved in type 2 diabetic patients over the last 12 months? Alternatively, how much time did nurse practitioners devote to care management?


Software For Care Management

Healthcare companies may use care management software to assist them streamline their care management processes. Many items may be scaled up or down to fit the demands of major health systems or small primary care offices. However, in every scenario, EHR integration is critical.

Consider the following software packages and features:

  • Analytics. These are tools that assist physicians in identifying and tracking specific patient demographics, as well as tracking results and performance.
    Intake of patients. Many functions that support care management programs, such as mobile registration, collection of patient-reported outcomes data, patient outreach, and analytics, are automated and streamlined by a comprehensive patient intake management solution.
  • Making a Care Plan This program compiles information and helps care managers to construct complete treatment plans for specific patients.
  • Patient involvement is important. A patient portal, secure messaging, educational materials, appointment reminders, and other patient-centered features are provided through these products.
  • Coordination of care. This software platform provides care team managers with tools for pre-visit planning and predictive risk classification, as well as data on patients' admission, discharge, and transfer monitoring.
  • Coordination of clinicians. This program keeps track of how much time clinicians spend on visits and tasks related to care management.
    Reporting. This tool monitors the progress of a care management program over time.



Care management has become a popular practice-based technique for managing the health of people with complicated or chronic illnesses. Treatment management programs may enhance the quality of care and help patients improve and maintain their health by merging systems, science, information technology, and encouragement.