Today’s care managers face a variety of challenges with many handling a higher volume of complex patient cases than ever before. At the same time, value-based care delivery and reimbursement models demand that care managers keep a close eye on healthcare costs while still managing their day-to-day. Care managers perform a continual balancing act, as they advocate for and coordinate the best possible patient care and conform to restrictions imposed by payers and government regulations.
A recent article in CMSA Today outlined the value that professional care managers strive to deliver:
- Using evidence-based practice and critical thinking skills to connect the dots and close gaps in patient care
- Engaging and empowering patients in healthy behaviors to increase wellness
- Ensuring quality and safe care, while acting as a good steward of payer funds
Achieving these goals can be easier said than done in today’s ever-changing healthcare system, however, when care managers are faced with silos of information in numerous systems, piles of administrative paperwork, increased incidence of chronic conditions, and an older, more ethnically diverse patient population.
To be successful in their roles, care managers must have access to a comprehensive, holistic view of each patient across the care continuum. This is the only way to identify and deliver the right care to individuals at the right time. One way to achieve this goal is by leveraging technology in ways that breaks down silos and simplifies routine work, while enabling care managers to provide the “human touch” to patients in meaningful ways.
Care management software solutions like HMS' Essette enable care managers to effectively collaborate and coordinate care with the interdisciplinary team across multiple care sites, and proactively identify and address potential health issues that may be on the horizon for their patients through targeted interventions.
Leading care management software solutions empower care managers in four key ways:
- Provides access to comprehensive member snapshots that integrate data from multiple systems.
Data is the key to evidence-based practice. To quantify risk of hospital readmission and identify non-medical determinants of health, care managers need patient information related to cost and utilization, lab results, pharmacy records, and more. If this data is scattered across multiple systems, it becomes too time-consuming for care managers to access. Essette unifies this information, so care managers no longer have to struggle with data silos to understand each patient’s unique situation.
- Reduces the number of clicks per task with intuitively designed workflows.
Essette was developed in collaboration with nurses and care managers. As a result, workflows reflect how these professionals actually perform their work. The technology is designed to support care managers, rather than hinder them, so unnecessary clicks and steps have been eliminated. Because of Essette’s intuitively designed workflows, care managers are able to spend less time on checking off the task at hand and more time on strategic initiatives like closing gaps in care.
- Automates administrative duties and correspondence across care sites.
Care management isn’t just about facilitating patient care. It also requires significant paperwork and administrative tasks. Essette automates care plans that are tailored to each patient. In addition, the system generates member correspondence, authorization and compliance, adjudication of authorizations, and referrals. By automating these critical components, care managers are able to dedicate more time to other facets of their multi-layered jobs such as quality improvement reporting and benchmarking to meet regulatory demands in today’s value-based care environment.
- Offers visibility into data to easily identify and address gaps in care.
With Essette, care managers have greater visibility into patient risk. They can monitor prior authorizations, inpatient stays, and concurrent and retrospective reviews. With access to high level and detailed information at their fingertips, it’s easier for care managers to spot potential gaps in care, identify potential areas for concern and take immediate action by providing targeted interventions to the right patients at the right time.
To meet the needs of the modern care manager in today’s value-based care environment, healthcare organizations need to leverage next-generation solutions. Leading care management software solutions shift the focus in the right way: care management professionals can spend their time coordinating the best possible patient care, rather than generating paperwork and juggling tasks in multiple systems. With the right care management software, it’s possible for care managers to meet their professional goal of facilitating high-quality, patient-centered care while efficiently managing claims and containing costs for the organization.
To learn more about HMS' next-generation approach to care management software designed for today’s care manager, download this free white paper.