All this about care management sounds good, but does it work?

The evidence about care management benefit

So, the question is – does care management “work?” Meaning, does care management deliver important outcomes such as improvement in patient clinical measures, satisfaction with care, or reduced cost to the health care system? The answer is a qualified “yes,” depending on which outcome, for what condition, and on how the care management was implemented.

Care management was originally implemented in the form of telephone-based disease management programs. These were off-site programs usually run by insurance or disease management companies to identify high cost patients. Usually a nurse would reach out to them by phone to engage them in disease management. These programs often suffered from low engagement rates and separation from the patient’s care provider. Therefore, their effectiveness was quite variable.

With the influence of the chronic care model and the patient centered medical home, much more care management moved directly into the primary care practice setting, which we call “embedded” care management in this guide. Again, the results are variable and depend on the condition under study, but the results are generally much more favorable. There is a growing evidence base demonstrating the overall greater effectiveness of care managers embedded in the primary care practice, with the care manager as a team member, and other team members contributing to the care management work effort.

Programs that focus on care transitions in an attempt to reduce hospital readmission have generally fared well. They reduce readmissions, improve coordination with primary care after hospital discharge, and reduce emergency department usage.

What are the benefits of having a care manager in the practice?

In a nutshell, practices—once they get a good care manager and have successfully implemented care management processes/workflows—cannot stop raving about the benefit of care management in their practice in terms of improving the quality of care they provide for their patients and how it has reduced stress and taken some of the burden off of the clinicians and other staff.

By Complete Care Management, Inc.