Care managers are constantly striving to deliver the right care to the right patients at the right time. In the absence of timely information about a patient’s condition, however, care managers can feel like they’re playing a guessing game about who they should target for meaningful interventions.
To deliver optimal care and move the health care needle in a positive direction, care managers need tools that facilitate data-driven decision making. Different types of patient-focused analytics can highlight opportunities for helpful health interventions before serious health events occur. Examples include:
- Johns Hopkins Adjusted Clinical Groups. This framework anticipates a patient’s health over time, based on information derived from electronic medical records, medical claims, and demographic data such as age and gender. These analytics offer visibility into patient risk and expected health care utilization.
- NYU Avoidable ED Algorithm. This model analyzes information from patient charts, such as symptoms, vital signs, diagnoses, and more to identify whether emergency room visits could be avoided through proactive health measures.
- NCQA Quality Measures. This performance improvement tool offers over 90 measures across six domains of care. These include effectiveness of care, access and availability of care, experience of care, utilization and risk-adjusted utilization, health plan descriptive information, and measures collected using electronic clinical data systems.
Thanks to these metrics and analytics, care managers can develop a clearer picture of member-risk profiles. That information shows which patients need extra attention and what type of help they may require. Analytics are also beneficial for care management leaders who are focused on regulatory compliance, cost and utilization metrics, and other business priorities.
Given the typical care manager’s workload, calculating metrics is the last thing they have time for. The good news is that HMS’s Essette care management system can automatically generate dashboards and reports with analytics related to population health, regulatory compliance, and more. Imagine if your care managers could:
Predict patient care quality and outcomes.
With metrics related to gaps in care, population health management, provider performance metrics, and more, Essette enables care managers to anticipate which patients may be at risk and then proactively identify interventions. For example, it may be helpful to aggregate issues based on diagnosis or demographic characteristics. This can identify at-risk groups and obstacles related to transitions in care. Key metrics can be included on customizable dashboards.
Generate reports themselves to explore different health dimensions.
Since care managers are on the front lines of patient care, they often have hunches about what may be driving health issues. Traditionally, care managers have had to ask IT to generate reports. Essette puts reporting power into care managers hands, with a user-friendly report builder.
Drill down from high-level patient metrics into more detailed information to uncover insights.
When a health plan wanted to reduce hospital readmissions, it started to analyze patient data using Essette’s Advanced Analytics module. This work revealed that a substantial number of members were experiencing social service issues related to readmissions. This readmissions driver has been previously overlooked, but now the team knew where to focus its efforts.
Leading healthcare organizations have discovered how incorporating analytics into care management can optimize health plan performance, while also improving patient care.
To learn more about HMS Essette’s next-generation approach to care management software designed for today’s care manager, download this free white paper.