What is Care Management?

Focused on the patient and involving an entire team of providers, care management is, in the simplest of terms, collaborating to improve outcomes. More than care coordination, however, care management is an episodic approach that also more effectively manages population health. The goals of care management programs include reduced costs, reduced hospitalizations and emergency room visits, and increased patient satisfaction.

AHRQ defines care management as a “fundamental vehicle for managing the health of populations,” adding that care management “is organized around the precept that appropriate interventions for individuals within a given population will reduce health risks and decrease the cost of care.”

AAFP outlines some of the activities involved in a care management program:

  • Patient education
  • Medication management and adherence support
  • Risk stratification
  • Population management
  • Coordination of care transitions
  • Care planning

(Learn how to coordinate care more effectively with Elation’s Collaborative Health Record.)

Why is care management necessary? Many patients see more than one provider, particularly those with chronic or complex condition. Ensuring that all patients understand the full spectrum of their diagnoses and treatment plans, are on appropriate medications, and have support throughout their healthcare programs will make a significant difference in their outcomes. A report published by the Robert Graham Center states:

On average, Medicare patients see seven physicians at four practices. A staggering 75% of hospitalized patients are unable to identify the clinician in charge of their care. Nearly 20% of Traditional Fee-For-Service (FFS) Medicare beneficiaries are re-hospitalized within 30 days of discharge, and half of those patients failed to see their primary care provider (PCP) in the interim.

Care management is one of the five key functions of patient-centered medical homes (PCMH). The PCMH is focused on the continuing care of the patient, rather than simply treating one condition for a limited period of time.

In a PCMH, the primary care physician is able to engage the patient, to ask pointed questions, and to observe changes or signs that may need further exploration by a specialty provider or diagnostic lab. Care management enables that physician to also manage patients’ visits and treatments outside the primary care office, ensuring that the overall care plan is appropriate and effective.