Traditional disease management has historically been treated and tracked by condition with separate departmental IT systems.
The rise in co-morbidities – with obesity being one of the main drivers – is requiring payers to implement fully integrated, patient-centric IT systems to determine which multiple management programs best meet a patient’s needs, said Lynn Dunbrack, program director for Health Industry Insights.
For example, a diabetic being treated for depression could easily be placed in disease, utilization and case management, requiring coordination of care among multiple departments to reduce redundancy, streamline operations and improve member experience, said Keith Dayton, executive vice president of sales and marketing at Click4Care.
A platform needs not only to aggregate data but also to incorporate analytics and workflow and communication tools, he said.
Dunbrack agreed. Data warehousing, business intelligence and clinical analytics, as well as physician tools are key components to an effective care management program, she said.
In the evolving care management software market, the application of analytics tools has made care management software stronger, she said. The ability to get at clinical data and identify at-risk, moderately at-risk and even the potentially at-risk members and stratify the population will positively impact current and future healthcare costs, she said.
With health plans under pressure to improve financial performance and clinical outcomes, they – as well as employer groups – want the ability to report clinical outcomes that manage and measure interventions, Dayton said.
Collaboration for care management involves more than just the member, care manager and primary care physician, said Kim Ingram, senior vice president of Clinical Solutions at Click4Care. Area agencies, specialists, family and friends and pharmacists, who are instrumental in compliance, are part of the collaborative care team. “You need to know who all the touch points of the member are,” she said.
Successful care management programs employ a high-touch model because studies have shown that high touch leads to better compliance. While coaching is a big component of high touch, IT enables it, Dunbrack said.
