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What are the benefits of care management?

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While care management is typically thought of as an effective healthcare approach for patients, independent physicians, and their practices can also realize benefits from implementing such plans. Ranging from improved finances to higher quality outcomes, the positive results of care management can be seen in a number of areas.

Care management brings together the patient, the primary care provider, specialty providers, and the patient’s family and caregivers to coordinate care for the best possible outcomes for that patient. Care management particularly benefits those patients with chronic or complex conditions who see multiple providers and require diagnostic or laboratory services in addition to medications.

The Department of Health and Human Services (HHS) states that “by 2030, 25 percent of the U.S. population will be 60 and older, and 19 percent of the population will be 65 years of age and older. At least 90 percent of those 65 and older now have one or more chronic conditions.” Further, HHS explains that if the health-related needs of this population are not met appropriately, through enhanced clinical and community coordination, that “may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.”

Care management delivers benefits to the aging population and those patients with chronic conditions by:

  • Reducing treatment costs
  • Reducing the rate of hospitalizations
  • Eliminating unnecessary and redundant testing
  • Managing medications to prevent adverse interactions
  • Involving the patient’s family and community to boost emotional well-being
  • Ensuring the primary care physician maintains a complete picture of the patient’s overall health
  • Enabling the provider to properly manage all care, improving outcomes for the patient

In its publication, Health Plan Innovations in Patient-Centered Care: Care Management, the Alliance of Community Health Plans examines a number of case studies that demonstrate reduced emergency room visits and hospitalizations, reduced costs for the provider in treating the patient, and improved “health status and health-related quality of life” for patients included in care management programs. Costs are significantly reduced by proactively coordinating care among the healthcare providers and engaging patients to be more involved in their own healthcare program.

The bottom line for patients and providers is that care management, by enabling the primary care physician to provide more efficient and coordinated healthcare, improves outcomes and reduces costs for all involved.