HOW CARE MANAGEMENT EVOLVES WITH POPULATION MANAGEMENT

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2 Reform and rising costs continue to push the importance of care management systems to the forefront. With the growing prominence of population health for provider organizations, provider-based care management becomes a critical bridge that ties the analytics of the population to proactive care interventions. According to a December 2013 HealthLeaders Intelligence survey, health system leaders will make care management programs a top priority in 2014 and beyond. The survey polled 142 senior, clinical, operations, finance, marketing, and information leaders across the healthcare spectrum. The majority of respondents were from nonprofit organizations (71%), while the remainder (29%) came from for-profit settings. Despite their infrastructure differences, the surveyed health systems face similar challenges in order to thrive amid changing payment models. For example, they will increasingly need to work toward developing integrated solutions to keep their patient population and surrounding communities healthy. As further proof that care management is a compelling objective, 68% of survey respondents said they planned to restructure their care management program in order to engage in population health and risk management within the next months. Care Management Catches On Andrew Mellin, MD, medical director of McKesson, says the framework of a new care management process has emerged with the rise of patient-centered medical homes, for example. He notes that in the past, physicians and healthcare organizations weren t face to face and had no economic incentive to manage patient care. ANDREW MELLIN, MD Medical Director McKesson Some of the key elements of care management are, number one, having a set of tools and processes in place so care managers are guided in a way that allows them to operate efficiently and use evidence-based best practices as they work with a patient. With the payment changing to shared savings or value-based contracts, the incentives to provide high-value care and keep those patients at lowest settings of care are now becoming decidedly aligned with the provider organization, says Mellin, whose company provides software solutions to healthcare organizations. One of the keys to care management, he adds, is being able to understand the risks in a health system s population and then risk-stratify an individual to the appropriate level of care management. Some of the key elements of care management are, number one, having a set of tools and processes in place so care managers are guided in a way that allows them to operate efficiently and use evidence-based best practices as they work with a patient, says Mellin. The second key element is the physicians need to be engaged and understand the role of the care managers, but the burden of care management should not be placed directly on the physician. The third element is focus. You need to have an analytics solution that aligns and identifies what it is you want to focus on first and where you will have the biggest impact. 2 McKesson I Sponsored Material

3 No matter the care management approach, the focus must still be on patients, says Ann Oasan, vice president at Omaha-based UniNet, an 18-hospital clinically integrated network that participates in the Medicaid Shared Savings Program. Oasan isn t surprised that the majority of survey respondents specified they would restructure their care management process; such responses are indicative of how challenging the transition is from fee-for-service to value-based care. I think we are like everyone where we ve got a foot on the shore and a foot in the boat, she says. We re moving towards value-based while still being reimbursed for fee-for-service. Oasan says one of the challenges is simply getting data into our tool, but once this is achieved, the results are very powerful. ANN OASAN Vice President UniNet Why Data and Analytics Are Critical James Barr, MD, is medical director at New Jersey based Atlantic ACO. Accountable care organizations are unique, with their financial success dependent on keeping patient populations healthy instead of just focusing on the provision of services. At the ground level you need provider and patient engagement. These groups will each need tools to support their engagement. Care management and performance improvement will then require a focus on the right data and analytics. Barr asserts that the key to all ACO functions, including care management, care coordination, and care transitions, is managing efficiently and effectively. What is essential is your data and analytics, Barr says. Your ability to Care Management Changes Under Consideration I What care management changes are being considered by your organization? 79% Area of focus (e.g., from Type 2 diabetes to chronic heart failure) 47% Increase the number of care management programs The number of care management programs 39% Incentive approach (e.g., positive versus negative reinforcement) 39% Changing ratios of care managers to patients 35% Base = 96 / Multi-response / Among those restructuring care management 3 McKesson I Sponsored Material

4 aggregate data from multiple sources and perform the accurate and actionable analysis of the data, that s first and foremost. That s where technology can positively impact workflow and help staff work smarter, he says. Using the McKesson Population Manager TM and McKesson Risk Manager TM products allows me to take the data coming into that software system, bring it into my workflow, and help me reach out to the people who are in need the most. According to Barr, it s also vital to educate the physician s clinical staff and the patient-centered team on how they can use the data and technology. You also need a program that acknowledges and rewards not just processes of care, but actual patient outcomes, Barr says. Building sound population health management systems begins with a strong focus on prevention and chronic disease management. This is likely why 79% of survey respondents indicated that a specific area of focus, such as Type 2 diabetes or heart disease, would be their primary step in care management going forward. Such a response comes as no surprise to Mellin. When you switch to value-based care, what changes is that the outcomes become much more important the outcomes of keeping patients out of the hospital, the outcomes of keeping them out of the emergency room, he says. Hospitals are increasingly augmenting their staff with care managers in order to effectively manage population health. According to the survey, 47% of respondents said they would increase the number of care managers. Also according to respondents, nurse care managers will hold the primary responsibility for the care Primary Responsibility for Care Management Process I Who will hold primary responsibility for the care management process in your organization s approach to population health and risk management? Nurse care managers at our hospital/health system 43% Various clinical staff supported by technology 20% Primary care physicians in our network 15% Nurse care managers at primary care practice within our network 13% Nurse care managers from an outside resource 3% Other 6% Base = McKesson I Sponsored Material

5 Using Technology to Support Care Management Efforts I How will technology support your organization s care management efforts? It will be integrated with clinical, business, and analytics functions 60% It will be used at the point of care in the physician s office 48% It will be centralized at the hospital/health system level 46% It will be used in conjunction with a health plan 33% Base = 142 / Multi-response management process (43%) in hospitals and health systems. Meanwhile, 20% of respondents said various clinical staff would hold the responsibility while supported by technology. Technology as the Solution to Integration Finding gaps in care is what care management and population management are ultimately about. It is like everybody says about the whole continuum of care, how do we make sure that those transitions are done because that s where the holes come in where you lose the patients, Oasan says. As evidenced by the 60% of respondents who indicated they would integrate care management efforts with clinical, business, and analytics functions, it is often most beneficial to seek technology tools that facilitate integration. We have used a McKesson tool since 2010, says Oasan. The system reveals gaps in care on specific patients. Also, the data lets us also look at the performance of our providers. Mellin points out that while there isn t a perfect solution to care management yet, it s still critical to start putting the proper infrastructure in place. If organizations are not actively planning on how this will evolve in their organizations over the next 12 to 24 months not just the technology, but the change management, the governance, the provider engagement, the patient engagement, and thinking about how this is going to work at scale they re going to be left behind, says Mellin. Now is the time to figure out what works well and what doesn t within your setting, and, again, be prepared to move this to scale quickly as value-based payment models continue to grow very rapidly. n 5 McKesson I Sponsored Material