- Care Management
- Chronic Disease
Many of the initiatives emerging from the Affordable Care Act (ACA) can help case managers address the long-term health of our nation with improved access to care and better preventive care options. However, the patients we deal with on a daily basis can’t wait for benefits to become active, especially patients with the most intensive health care needs who generate the highest costs.
At Medical Management and Rehabilitation Services (MMARS), we address those issues one patient at a time, each and every day. Through our years of case management experience, we have learned that our greatest impact on health, and in turn, financial outcomes, comes from taking a proactive approach to the health needs of our highest utilizing patients, and collaborating with their providers and payors.
We use an integrated approach to patient care that engages technology to identify high-risk, high-use individuals using clinical information like hospital admission data. Our nurses also collect information through comprehensive health-risk assessments, patient interviews, and clinical data to identify utilization patterns and risk factors for each patient.
The MMARS team then relies on evidence-based tools to build a care treatment plan that our case managers implement with our highest utilizers. Off-the-shelf case management is not the answer. Smart, proactive care management tailored to the specific needs of the patient can help provide the impact and change necessary to improve health outcomes and lower costs.
Over the years, the care management model has changed dramatically. It was not too long ago that utilization review programs were in vogue and case management was just beginning to gain traction through programs funded by private and public payers.
Today, case managers are focused on making sure patients are getting the right care at the right time through enhanced care management models. It’s no longer about denying care, but making sure each patient is receiving the appropriate services to promote the most positive clinical and financial outcomes possible in any given circumstance.
This approach has led to a much more dynamic, customized approach to care management. MMARS, among other organizations, is on the front wave of this trend. We work with different program sponsors to design, implement and maintain high touch, dynamic interventions to help targeted populations address their chronic and acute care conditions.
Our ability to create these customized approaches is due to advancements in health information technology, evidence-based clinical pathways, more flexible staffing models, and enhanced communication platforms – among other resources.
With Chronic Disease Management and Prevention/Wellness being covered as one of the Essential Health Benefits under the Affordable Care Act, it’s important all of us work with policymakers, providers, payers and others to ensure that the latest in care management strategies are being deployed in the health care market place. If you want to learn more about these opportunities, please give us a call.
An exciting aspect of the care management field is the swift pace that new innovations and interventions come to the market to help manage and support individuals with a wide range of chronic conditions. One characteristic of such an evolving landscape is the use of new terms and names to describe care management programs, such as the recently coined term “population health management.”
As a result of health care reform efforts and other activities that are promoting a more integrated delivery system, it’s exciting to see how more payors, providers and others are coming to appreciate the need to proactively manage patients through the continuum of care both at an individual and population levels.
Irrespective of what the program is called, however, it’s important to remember that the basic tenants of complex, condition management services remain the same. Key elements include using predictive modeling applications, engaging in risk assessments to assess individual health status, developing customized care treatment plans that control for each individual’s co-morbidities, using evidenced-based clinical pathways, ensuring that patients and attending providers are engaged in the longer term care plan, measuring the success of programs through robust outcome assessments, and so on.
MMARS has been a leading expert in the field using these core care management tools in both private and public sectors for years. In fact, MMARS developed the medical management program that became a cornerstone of one of the most successful accountable care organizations (ACOs) in the United States—even before the term ACO became fashionable.
Give MMARS a ring if you would like to talk about population health management strategies and/or the fundamentals of care management interventions. We look forward to connecting with you. Also, stay tuned to this blog as we post important updates impacting the medical management field.