Increase the ROI of Every Care Management Activity

How can you increase the ROI of every care management activity to get more value from your care management program? The strategies in this blog post can help!

Here are two primary strategies to employ.

1.    Right-size Care Management

Authors of a McKinsey & Company article suggest tailoring the intensity of care management (e.g., care team size and expertise, frequency of interaction, and mode and length of engagement) to the needs of a targeted population or individual.

For example, a patient with type 2 diabetes who isn’t insulin dependent and has a controlled A1c of 5.8 does not need the same approach as a patient who is insulin dependent, rarely takes their medication correctly, and is consistently getting A1c readings over 8.

Another factor in right-sizing care management is to consider the social determinants of health that may impact a member’s ability to follow their care plan. For example, expecting a member to go on a special diet to improve their health when they’re struggling to put food on the table isn’t helpful. But connecting them with special services such as Meals On Wheels and community-based support can be the ticket to success.

2.    Focus on Areas With the Potential for the Greatest Impact

In addition to membership-wide initiatives, there are specific areas care managers can focus on to yield the highest ROI. Is your care management program designed to do the following?

• Address gaps in care that will make a positive impact on patient outcomes and performance metrics.
• Employ predictive analytics to prioritize populations and focus services on top priorities and pain points.
• Engage members when they will be most receptive to care management, such as around surgery or discharge from a hospital.
• Facilitate smoother care transitions to ensure proper follow-up and adherence to care plans, as well as avoid unnecessary hospital readmissions.
• Verify members understand how and when to take their medications, and why they are important.
• Ensure clinical, social and community-based care management needs are met, including resources that can help address social determinants of health.
• Communicate with members through their preferred communication channels, increasing engagement and satisfaction.
• Empower individuals with the information and tools to manage their own health.
• Help patients self-navigate symptoms and gain access to patient services quickly and efficiently.
• Make high-value decisions that avoid clinically inappropriate spend and encourage others to do the same (e.g., guiding members to in-network providers and appropriate care sites).
• Introduce automation where possible, such as using technology to streamline the prior authorization process and reduce the administrative burdens of clinicians and their care teams.

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