Care Management Systems – the Next Major Healthcare Product – Part 2

Contributor: Sandeep Puri, WG’99
To learn more about Sandeep, click here.


This article is Part 2 in a 2-part series on care management systems (CMS).  In Part 1, I made the case that care management systems are the next major healthcare product.  A new generation of care management systems is evolving driven by patient-centric and value-based healthcare models.  These new generation care management systems include patients in the management of care, enable the entire care team to track patient health and collaborate, and engage patients outside the healthcare facility, not just inside. In Part 1, I also shared my thoughts on the 5 Attributes of a robust care management system.  In this article, I share my point-of-view on the 10 capabilities of a robust care management system.  

10 Capabilities of a Robust CMS

1. Flexible Patient Data:  Capability to import data from EHR systems, patient portals, practice management systems, HRA data, or claims data from payer systems.  Data could include demographic and clinical information to help identify and target patients for specific care management programs, as well as patient preference data, if available, for personalized communication.  Depending on the complexity of the programs, data intake could happen through secure file transfers or through integration with the data sources.   

2. Targeting Analytics: Functionality that allows the Administrator of the care management program to identify the target patients for each program based on demographic (age, gender, geography) or clinical (diagnosis code, medication, vital signs, lab tests, etc.) characteristics.  This enables the provider to send customized content to patients that is relevant to them.     

3. Customized Program Development: Capability to quickly and easily create custom content (e.g., notifications, questionnaires) for each care management program.  The functionality should allow the Program Administrator to either use content that has been previously developed by the provider, or easily create new content using templates and libraries in the care management solution.   A robust solution will allow easy customization of programs for different segments of the population based on preference or medical situation, e.g., email or text version for the tech-savvy population, phone version for the tech-challenged population, Spanish version for the Spanish-speaking population segment; and different versions for patients with co-morbidities based on their care plan.      

4. Personalized Program Administration: This capability allows the Program Administrator to personalize the engagement with target patients by sending relevant content, in the preferred mode, in the preferred language, at the preferred time to each patient.  A robust care management system will have the intelligence to not only automate the personalization based on expressed preferences, but also the adaptive capability to learn from past patient behavior.      

5. Response Analytics: This capability tracks patient responses and enables the Program Administrator to evaluate response rates by channel of communication, by geography, age, gender, facility, provider, etc.  This allows the provider to optimize the channel mix and content to maximize the ROI of programs.  

6. Alerts Management: This capability analyzes patients’ survey responses to identify gaps in care and enables automated alerts to be generated based on the rules defined by the provider.   Alerts management can be customized to alert different members of the care team (e.g., nurse, doctor, nutritionist, social worker) depending on the question and the response.  The capability enables the care team to view the alerts generated for each program and each patient, and allows them to manage large populations with exception-based interventions. A robust care management solution will provide follow-up alert-based interventions and educational components that support the patient through the program.  

7. Rewards Management: The capability enables providers to encourage patients to change behavior and sustain behavior change by rewarding the desired behavior or activity, e.g., points for responding to a questionnaire or taking their medication on time. Points can be collected and compared with others in the program (social competition), or converted to financial or other incentives, if desired. The rewards act as a positive reinforcement which increases engagement and makes the process of self-care management fun and rewarding.  

8. Care Manager Dashboard and Workflow Tool: The Care Manager Dashboard and Workflow Tool enables care managers to access the platform to view information on patients assigned to them, view the programs in which their patients are participating, track their responses, track alerts generated by their patients, and create notes and to-do lists for managing their patients’ health.       

9. Device Integration: The proliferation of internet-enabled devices and sensors has made it easier for patients to track and share information like weight, blood pressure, and A1C levels with their providers.  A robust CMS would enable integration with these devices so the information can be captured automatically from these devices using Wi-Fi or Bluetooth technology, making it possible for providers to analyze this data faster and more accurately.      

10. Backward Integration of Patient-Generated Data: Capability to integrate relevant patient-generated data into the EHR system (e.g., activity data, alerts) and patient portals (e.g., activity data, rewards data).  This enables integration with the clinical workflow and allows providers to see the patient-generated data within the EHR instead of having to refer to multiple systems.   

Surveys show increasing adoption of the new-generation care management solutions – by providers and consumers.  There are several drivers for this growing uptake.  The Affordable Care Act is creating incentives for providers to adopt these new solutions – with delivery and reimbursement models that shift emphasis from sick care to wellness.  Secondly, consumer interest and participation are increasing with the increase in consumer-driven health plans (CDHPs).  And finally, the increasing penetration of smartphones, wearables, and EMRs is clearing the path for technology adoption.  However, some barriers still exist.   As an industry, there’s still more work to be done around reimbursement models that encourage remote care management, health information exchange, security, and evidence-generation. But then, Rome wasn’t built in a day!    

My firm, Patientriciti, 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.  Patientriciti’s solution is based on the 5 attributes and 10 capabilities outlined in these articles. 
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