Smart Health Communities: How Care Management Can Improve Efficiency and Reduce Costs

January 21, 2020 HMS

As the year 2020 begins, we are embarking on a new decade filled with new possibilities. This is a great opportunity for the healthcare sector to reexamine how it delivers care and consider how to work more efficiently and cost-effectively.

Last year, the Deloitte 2019 Global Health Care Outlook report identified seven characteristics of “smart health communities.” These could be a good place for health plans to start, as they strive to improve care in the years ahead:

  1. The right treatments are delivered at the right time and place, and for the right patient.
  2. Clinicians utilize technology to diagnose and treat illnesses more accurately, as well as to deliver care.
  3. Care delivery stakeholders across the ecosystem communicate and use information effectively and efficiently.
  4. The right people are assigned to the right work.
  5. Patients understand their treatment plans and are actively involved in them.
  6. New, cost-effective care models deliver healthcare to places and people that don’t currently have health services.
  7. Efficiency improves and waste declines.

Coordinated care clearly plays a central role in smart health communities. This is also a foundational element of both value-based care and care management. Chronic diseases require long-term management and proactive care models tend to be more successful than reactive ones. In addition, effective patient engagement typically leads individuals to take better care of themselves.

In light of these facts, payers have started to recognize the value of care management. In 2015, the Centers for Medicare and Medicaid Services (CMS) implemented a new chronic care management billing code. Both CMS and private payers are now beginning to support the provision of care management services.

To support the development of smart health communities, many health plans are leveraging technology to coordinate care management programs and to reduce cost variations at scale. HMS’ Essette care management solution, for example, provides plans with a 360-degree view of members. Case managers can create individualized plans based on evidence-based care programs to support different members’ health needs.

Essette seamlessly manages interdisciplinary care teams, while supporting individual member assessments and monitoring interventions. It interfaces with existing tools such as eligibility and claims systems, analytics solutions and online portals.

Case managers find that Essette puts data-driven, actionable care plans at their fingertips. Those plans can be routed to providers across the entire continuum of care. Organizations using Essette report a 250% increase in the number of members supported through Case Management.

Thanks to technology-based care management solutions like Essette, health plans can deliver on many of the aspects of smart health communities. Providers across the care ecosystem communicate more effectively which means the right interventions are provided to the right members at the right time. Patients understand their treatment plans and play an active role in them. From a resource utilization perspective, efficiency is improved. Better care at a lower price is a great goal for the 2020s. Care management is one key to making it happen.


As you gather information about care management platforms, we’d invite you to take a closer look at HMS Essette by downloading this free white paper.

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