Care Management Strategies Require Better Tools

Transcription

1 Care Management Strategies Require Better Tools

2 The ripple effect of healthcare reform is beginning to impact care delivery strategies as care management now falls increasingly to providers. According to a recent HealthLeaders Intelligence survey, hospital leaders are making progress with care management efforts, but more robust tools will be needed if hospitals want to scale up. The October 2014 survey polled 134 senior, clinical, operations, finance, marketing, and information leaders across the healthcare spectrum. The majority of respondents were from nonprofit organizations (63%), while the remainder (37%) came from for-profit settings. Regardless of potential infrastructure differences, the surveyed health systems will encounter similar care management challenges now and in the future. ANDREW MELLIN, MD Vice President and Medical Director McKesson Care Management Focus Varies The primary way organizations are achieving care management is by focusing their efforts on specific disease states (57%) such as diabetes and heart disease, according to the survey. Approximately 51% focus their efforts on high-risk patients. Other organizations are focusing on transitions of care (57%), highest-cost patients (45%), and postacute care settings (40%). The survey really elucidated the fact that organizations are deploying a number of different models of care management, says Andrew Mellin, MD, vice president and medical director for McKesson. But it also demonstrated that organizations don t have the tools in place to do care management at scale. Mellin says he isn t surprised organizations are focusing on care management since it is a core component of effective care models. Focus of Chronic Care Management Efforts Where is your organization focusing its chronic care management efforts? Specific disease states (e.g. diabetes) High-risk patients 51% 57% Transitions of care Highest cost patients (i.e., top 5%-10%) 49% 45% Post-acute care settings 40% Patient specifically identified by their providers 15% Other segmentation approach We do not have any care management efforts 4% 10% Base = 134 Multi-response 2 McKesson I Sponsored Material

3 Chronic Care Management Engagement Tools and Resources What tools or resources is your organization deploying to engage the patients who are receiving the highest level of chronic care management? Human telephonic outreach 69% Patient web portal 50% In-home visits 45% Automated telephonic/texting/ outreach 27% In-home devices/home monitoring 25% Web-based educational information 23% Mobile applications Other 11% 11% Base = 134 Multi-response Care management is going to be the key intervention that helps providers achieve the optimum outcomes with their patients, especially for those patients that have significant medical or sociodemographic risks. Andrew Herrick, PhD, director of product strategy for McKesson population health management solutions, expects the trend of value-based care to drive groups to take on more risk for subsets of the population. We re in a transition market where whoever owns the risk of a population bears the financial and clinical risk risk of that group of people, and have an interest in making sure that their population s health is optimized, Herrick says. Engagement Tools & Resources Care management efforts typically require significant human interaction, as seen in the responses to the survey question about care management tactics employed by hospitals and healthcare organizations. According to the survey, the primary way organizations engage with patients is through human telephonic outreach (69%). Approximately 50% of respondents deploy a patient Web portal as the primary tool or resource to engage patients who receive the highest level of chronic care management. It s clear today that most organizations are throwing people resources at [care management], and the second survey question demonstrates that almost 70% of care management in organizations are being provided by human-based telephonic calling, Mellin says. Those are additional nurses that your organization needs to invest in. There s a singular purpose with care management, but organizations are trying to address the challenge with multifaceted approaches in a variety of care settings, Herrick says. There s telephonic outreach, in-clinic 3 McKesson I Sponsored Material

4 coaching, Web portals, and even face-toface in-home visits. Each of these approaches have various degrees of success in engaging the patient into ownership of their chronic condition. Mellin says that while most people or organizations are using human interaction to engage patients, it is encouraging to see respondents are also eager to employ mobility and emerging technologies. Most people are using humans to engage their patients, and it s certainly encouraging to see patient Web portals at 50%, he notes. I think the time is right to see disruption; that s why I think this [survey] is showing that we re still in the early stages of technology and approaches that will I would bet that the 28% that said that they re using their EHR, what they ve done is they ve created some glorified spreadsheets within their EHR. ANDREW HERRICK, PHD Director of Product Strategy McKesson enable providers to grow and scale their engagement with patients. Case in point: St. Vincent s Health Partners, a physician hospital organization based in Bridgeport, Connecticut, utilizes a multidimensional operation plan with a suite of McKesson s software products that collects and aggregates data in monthly reports for each physician and practice. St. Vincent s participates in the Medicare Shared Savings Program, the Bundled Payment Care Initiative, and commercial ACO quality and self-insured contracts. Since each program has unique quality and performance requirements, St. Vincent s has developed medical management services to achieve all its requisite goals. Our model utilizes multivariate analysis to develop a list of patients requiring high-, moderate-, and low-touch engagement strategies, says Michael Hunt, DO, chief medical officer/chief medical information officer. Each month, this data allows physicians to provide multiple levels of patient engagement to successfully manage those patients with the highest risk as well as patients who are healthy and need care gap resolution. Status of Automated Chronic Care Management Workflow Tool Status of Automated Chronic Care Management Workflow Tool? Percent Yes, as part of the EHR 28% Yes, as a solution separate from the EHR from a commercial vendor 9% Yes, as a solution separate from the EHR that was built internally 7% No 56% Base = McKesson I Sponsored Material

5 Automated Workflow Tools Still Lacking Perhaps the most surprising and instructive result of the survey came from the final question about the status of automated workflow tools. Over half of respondents (56%) indicated that their organization does not have an automated chronic care management workflow tool. The remainder said the automated workflow tool is part of the EHR (28%) or a solution separate from the EHR, either from a commercial vendor (9%) or built internally (7%). Herrick says many hospitals are still struggling to support care management services. Many rely on spreadsheets when more robust tools and platforms need to be in place. I would bet that the 28% that said that they re using their EHR, have created some glorified forms and templates within their EHR, he says. They use them because they are flexible and reside within their EHR system to track this type of activity. Our model utilizes multivariate analysis to develop a list of patients requiring high-, moderate-, and low-touch engagement strategies. Herrick continues, Because of the infancy of care management within provider organizations, they are still using common tools, like Word documents, SharePoint sites, and spreadsheets, to do all of their documentation, tracking, and patient education. However, providers are beginning to realize that performing MICHAEL HUNT, DO Chief Medical Officer Chief Medical Information Officer St. Vincent s Health Partners care management at scale requires a whole new set of capabilities. First, you need to stratify the population, says Mellin. You need to understand who to focus your energies on. Who are the patients at high risk for hospitalization or who are predicted to have suboptimal outcomes? That information is often not readily available inside an EHR and has to be done through analytical processes. More importantly, Mellin says, since the EHR was ultimately built on a fundamentally different model than population health, it is crucial now to invest in a care management platform. Many organizations are just starting to develop their models for care management, says Mellin. They will quickly learn that the EHR alone will not be sufficient. EHRs were never designed for care management, and they don t operate or provide the capabilities you need for care management. Half of respondents have no tool whatsoever to do their care management, and that s a real disconnect. About 90% of the people are doing care management, yet half of that don t even have a tool. Mellin emphasizes that with the move to provider-based care management, it s crucial to ensure that the workload is divided appropriately, tasks are followed up on, and the entire care team is collaborating and connecting together over a common longitudinal care plan. Ultimately, the most successful organizations will create for each person a patient-centric, blended care plan that provides a common set of goals and interventions to be managed by the entire care team. n 5 McKesson I Sponsored Material