The Keys to Seamless Care Management Across Populations

June 26, 2019 HMS

The Growing Complexity of Healthcare

The complexity of care management is growing. Chronic medical conditions reduce quality of life for patients and at the same time, these conditions are often costly to treat. For both of these reasons, many health payers want to develop care management strategies to address chronic health problems. In addition, payers are also concerned with preventing diseases and promoting patient wellness in the population as a whole. In this complex world, care managers must juggle diverse activities such as:

  • Promoting patient lifestyle programs like weight loss or smoking cessation
  • Identifying gaps in care, like missed preventative screenings, prescription refills, or follow up appointments
  • Engaging in intensive care management for patients with serious health issues

All of these activities must also meet standards and regulatory requirements. Keeping pace can seem overwhelming. Fortunately, technology solutions like care management platforms can help.

Creating Successful Care Management Systems

The most effective care management systems support data integration, flexible workflows, and usable interfaces. These three elements enable care managers to provide seamless care across a wide variety of populations.

  • Data integration. To get a clear picture of patient diagnoses, medical history, and clinical needs, care managers need to combine information from many different sources. They must synthesize claims data generated from inpatient, outpatient, and emergency room visits, pharmacy orders, and lab tests. Gathering this information manually can be daunting. It often requires accessing numerous systems and then creating a patient profile. Comprehensive care management systems like HMS Essette unify data from multiple systems into one platform. This simplifies the process of stratifying patients and identifying the appropriate interventions for each group. Since data is unified in a single system, Essette can also easily generate useful metrics and analytics to guide care managers’ decision-making.
  • Flexible workflows and business rules. Coordination and communication are at the heart of effective care management. Care managers are continually sending electronic messages and documents to patients, providers, and other key stakeholders in the healthcare ecosystem. HMS Essette supports flexible workflows and business rules, so care managers can automate many of their routine tasks based on their organization’s unique needs. For example, it’s easy to open and complete authorization requests on a single screen, with access to the relevant medical necessity guidelines. Care managers can also automatically generate assessments and individualized care plans which include key tasks and care recommendations.
  • Usable interfaces. The best technology solutions support user activities, rather than hinder them. The team that designed HMS Essette spent months sitting side-by-side with care managers and nurses and observing how they worked. As a result, the system screens and processes feel natural and intuitive to users. A recent KLAS article noted that population health initiatives are successful when teams have access to tools that work and that enable them to be better caregivers. This same concept can be applied more broadly to care management. HMS Essette simplifies administrative tasks so care managers can spend more time with patients.

Fragmented care can result in increased costs and poor patient outcomes. Fortunately, it doesn’t have to be this way. Care management systems can help organizations target patient groups, match them with the right programs and resources, and close gaps in care. To learn more about how your team can benefit from Essette’s approach to next generation care management, download our white paper.

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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