How can care managers improve performance metrics in addition to member outcomes?

By Medecision

Care managers face pressure to improve not only member outcomes but performance metrics as well. Here are three ways care managers can have a positive impact on both.

1. Focus care management on top priorities and pain points.

  •  Employ predictive analytics to prioritize engagement with at-risk and rising-risk populations.
  • Engage members when they will be most receptive to care management, such as around surgery or discharge from a hospital.
  • Facilitate smoother care transitions to ensure proper follow-up, streamline referrals, and reduce readmissions.
  • Make high-value decisions and encourage others to do the same (e.g., guiding members to in-network providers and appropriate care sites).

2. Leverage a strong data strategy and integrated solutions to improve performance metrics.

Ensure the technology used by care management teams enables the following:

  • Sharing the full picture of health with those involved in an individual’s care—from clinical, behavioral and community-based providers to individuals and their trusted circle
  • Individual- and population-level insights that empower care managers to identify and influence actions and outcomes
  • Near real-time, member-level data to inform care management workflows and trigger the right clinical and social interventions at the right time
  • Reporting tools to properly document activities and outcomes and meet compliance measures
  • Key analytics capabilities to identify gaps in care and stratify risk
  • The ability to apply clinical intelligence rules and leverage predictive modeling

3. Take a person-centric approach to care.

One size does not fit all when it comes to care management. Personalized digital engagement and a member-centric care plan are powerful tools in improving health outcomes and performance metrics. The more you know about an individual, the better the support you’ll be able to provide. Here is just one example:

A care manager grew concerned about a member who seemed depressed after hip surgery. The member commented that she was having trouble bathing, that she felt useless and she didn’t see the point in trying to get better. When the care manager pressed further, she learned the member had lived alone before she broke her hip. Because her front porch steps were too difficult to navigate safely, she moved in with her son after surgery and was staying on the first floor of his three-story home. With only a half bath on that level, she had been trying to keep herself clean without access to a shower. She missed her independence and felt like she was a burden.

When the care manager asked about installing a ramp for access to her own home, the member explained that neither she nor her son could afford it. The care manager connected the member with a community-based program that rallied volunteers to build the ramp for her free of charge. The member gained back her independence and as her outlook improved, so did her recovery.  

Discover more ways care managers can support improved outcomes as well as performance metrics – request your copy of our guide here.

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