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Patient care management

What is Patient care management?

Patient care management is a program that involves comprehensive health services to assist patients in managing their health, including primary care practices like scheduling appointments to short-term case management and chronic illness care management. It is a delivery method that requires support systems for enrolling or assigning patients to procedures across the health and illness continuum. 

Patient care management improves the quality of care and health of populations by reducing the per capita cost of healthcare by:

  • Identifying and categorizing populations with modifiable risk
  • Coordinating care to the needs of the population 
  • Recognizing, preparing, and integrating the right resources 

Chronic illnesses such as diabetes, high blood pressure, heart disease, and other long-term health conditions must be closely managed and monitored. Patient care management enables healthcare providers to effectively manage such situations with a comprehensive strategy and community resources. It proactively manages patients' health and well-being, even when they’re not in the doctor's office or hospital.

Elements of patient care management include: 

  • An effective team: Specialized care teams with defined responsibilities will promote communication and collaboration on patient medical conditions, therapies, actions, and care planning for patients based on their needs.
  • A customized data-centric care plan: Developed care plans based on specific needs of patients by collecting data from patients' EHRs, claims records, and other sources. It uses analytics software to sift through valuable information that can help you identify individuals who may benefit the most from care management, such as those with chronic diseases or high-risk and high-use patients. 
  • Medication and care-management tools: Strategized to encourage patients to participate in the program to manage their chronic conditions actively. An insulin vial-tracking log, for example, might be one such tool. Care management tools will help patients better understand their condition and how it affects them, which will result in better patient engagement. 
  • Hospital-to-home program: Hospital care isn't the only aspect of patient care management. Telehealth technologies and systems are employed to monitor the effectiveness of the care team and patients' health, allowing care managers to intervene and provide treatment at the right time without operational delays. 

Care management emphasizes the use of practice-based approaches for improving the health of populations with complicated or chronic medical problems. Healthcare organizations increasingly adopt care management software to enhance care management operations. Many solutions may be scaled up to meet the demands of large healthcare systems or downsized for smaller primary care clinics. EHR integration, on the other hand, is critical in every instance.

Benefits of patient care management include:

  • Enhanced clinical outcomes: The right combination of technology that automates and streamlines many tasks and reduces redundancy and allocates healthcare resources, enhancing clinical outcomes.

  • Time efficiency: Patient aids in previsit planning and risk stratification using patient data for immediate and targeted care.  

  • Cost reduction: Patient care management reduces unwanted allocation of resources, duplications, and no shows. 

  • Patient engagement: Patient care management develops methods for creating patient ports, secure messaging, instructional materials, appointment reminders, and other patient-focused services.

  • Enhanced revenue: Care managers proactively support the patient on track by following doctor's instructions and avoiding unnecessary emergency room visits and hospital stays, reducing the fee of service and increasing the number of billable clinical hours. 

  • Research and Innovation: A formalized data pool built up over time will aid organizations in quantifying and testing the effectiveness of new innovative technologies in patient care management.

  • CMS requirements: Extended Medicaid services patients by meeting Centers for Medicare and Medicaid Services (CMS) requirements.
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