Best Practices for Care Management of High-Need, High-Cost Patients

A new white paper from the Health Care Transformation Task Force evaluated essential criteria for care management services to incorporate in order to improve the type of care they provide patients.

Recognizing that about 20% of patients drive 80% of US healthcare, the Task Force developed the “Developing Care Management Programs to Serve High-Need, High-Cost Populations” report in order to determine how to best disperse services across the care management continuum, a series of services and interventions designed to improve care for high-need, high-cost patients. The goal was to suggest improvements in value of care, patient outcome, and to reduce unnecessary and costly care.

The purpose of care management programs is to offer high-quality patient-centered, patient-directed care at lower costs.

“Successful care management programs take many forms, yet all infuse effective patient involvement as bedrock principles,” according to the white paper. “Engaged patients, families, and support networks are critical to effective coordination of care across the continuum, whether it’s related to an acute episode, post-acute care, return to normal living situation, and community-based care—medical and psychosocial.”

The paper was divided into 3 key sections: the building blocks of care management, a selection of case studies from Task Force member care management programs, and lessons learned and important areas for improvement.

Building blocks for effective care management included identifying the target population, patient and family caregiver engagement, health assessments and screening tools, team-based are, care coordination and infrastructure, patient-centered care, health and disease management programs, transitional care, and quality measurement and evaluation framework.

The Task Force identified areas of improvement: 1) ensuring meaningful patient and caregiver engagement, 2) evaluating care management that integrates patient-reported outcomes and examines low- or no-value care, 3) defining the scope of care management programs demographically, 4) tailoring care management programs to individual patients, and 5) overcoming resistance to services by ensuring that providers are aligned with the values and goals of their programs.

In order to finally achieve this quality care, care management programs must change the fee-for-service payment system in addition to aligning financial incentives, confirming that infrastructure is interoperable, and be willing to transition to care management models.

“Our goal is to help health systems, payers, and policymakers enhance person-centered care management strategies, highlight opportunities for alignment, and identify areas where more evidence may be needed to understand the cost and quality impact of care coordination,” Task Force Executive Director Jeff Micklos said in a statement. “As appropriate care management services for this population continue to mature, innovative payment models must also be developed to promote effective and accountable delivery of these services.”