Care Management Systems – the Next Major Healthcare Product – Part 1

Some time back, I came across an article¹ about Care Management Systems written by noted healthcare blogger John Lynn.  The article indicated that after the Practice Management Systems (PMS) and the Electronic Health Record (EHR), the next major healthcare product is the Care Management System (CMS).  While the PMS managed the Practice (i.e., billing), and the EHR stored the records electronically, the CMS was going to be centered on the patient and the care that the patient receives.  In this Part 1 of a 2-part article, I elaborate on what a Care Management System is and the attributes of a robust Care Management System. 

So, what is a care management system? In previous years, traditional care management focused on processes related to the period of time that patients received treatment at a hospital.  These old-school care management systems typically (a) focused on documenting the care provided to the patient in the hospital only, i.e., did not extend across the care continuum; (b) did not facilitate collaboration between the extended care team and the patient; (c) did not allow patient-generated data to be incorporated into the system; and (d) did not enable registries and population health. 

Given the emphasis on patient-centric and value-based healthcare models, the argument in the article made sense to me.  By 2018, 50% of Medicare payments will be paid via alternative payment models such as ACOs or bundled payment arrangements, and 90% of traditional Medicare payments will be tied to quality- or value-based programs such as Hospital Value Based Purchasing and the Hospital Readmissions Reduction Program. Succeeding in these new delivery and reimbursement models will require better capabilities from providers (physicians and hospitals) for engaging patients and making them active participants in their care management. The new generation care management system will need to include patients in the management of care, enable the entire care team (PCP, specialists, hospital physicians and nurses, social worker, nutritionist, behavioral health counselor, discharge coordinator, etc.) to track patient health, collaborate, and engage patients outside the healthcare facility, not just inside. 

Several CMS solutions are being developed by digital health start-ups to meet the above-mentioned objectives. Patientriciti is one of these companies.  Here is our point-of-view on the attributes of a robust CMS system. 

5 Attributes of a Robust CMS  

1. Personalization: With the increasing “consumerism” of healthcare, patients – the consumers of healthcare – are expecting a personalized experience when they engage with their healthcare providers.  These consumers have been trained by companies like Netflix and Amazon to expect that their healthcare provider knows about their preferences. Patients engage and respond much more positively to these personalized experiences, which encourages loyalty and better adherence to care plans.  A robust care management solution will need to communicate with the patients in the mode (e.g., email, text, phone) they prefer, in the language they prefer, and at the time they prefer.  A smart care management solution will even learn and adapt based on past patient behavior.  

2. Behavior Change: Changing individual behavior is increasingly at the heart of healthcare. In a McKinsey analysis of US healthcare costs (which are now nearing $3 trillion annually), 31 percent of those costs could be directly attributed to behaviorally-influenced chronic conditions.  Fully 69 percent of total costs were heavily influenced by consumer behaviors. The burden consumer choices place on low- and middle-income patients is relatively more staggering.  A robust care management system will need to incorporate behavioral science strategies (e.g., rewards, gamification, social competition) to engage the patients and increase probability of changing behavior and sustaining behavior change. 

3. Ease of Use for Providers:  Providers are looking for care management solutions that are easy to deploy, use, and maintain, and that integrate seamlessly with their existing systems (EHR, PMS, patient portals).  A robust care management solution will be a cloud-based solution requiring no hardware or software installation on premise.  It will enable the provider to quickly create and administer customized care management programs, from anywhere, anytime, and using any internet-enabled device. It will allow the users to view real-time outcomes on a dashboard and allow ad-hoc reporting for program assessment and audit.  It will integrate seamlessly with the providers’ EHR system to obtain patient data for the care management programs and to feed relevant patient-generated data back into the EHR system to facilitate clinical workflow integration.    

4. HIPAA Compliant: Not much needs to be said here. A robust care management solution needs to be HIPAA compliant not just for compliance, reasons, but also for the solution to be effective.  To reap the promise of digital health information to achieve better health outcomes and smarter spending, providers and patients alike must trust that an individual’s health information is private and secure.  If patients lack trust in the Care Management solution, feeling that the confidentiality and accuracy of their responses is at risk, they may not want to respond to the care management solution.   

5. Scalability: A robust solution will be scalable and able to grow as client needs grow – from chronic disease management programs to wellness programs; from small to large facilities; and across systems and networks. 

Surveys show increasing adoption of the new-generation care management solutions – by providers and consumers.  There are several drivers for this – regulatory changes driving the shift to value-based reimbursement models; consumerism of healthcare driven by the rise in high-deductible, consumer-driven health plans (CDHPs); and technology adoption driving increasing penetration of smartphones, wearables, and EMRs.   

In Part 2 of this article, I will share my point-of-view on the capabilities of a robust Care Management System.  My firm, Patientriciti (www.patientriciti.com), has a multi-modal, multi-lingual, patient engagement and care management solution which helps providers and health systems reach and engage with different segments of the population in a personalized way to affect sustained behavior change.