Five problems with case management systems we can fix right now

Rucha Vyas

The growing burden of chronic conditions necessitates the need to look for innovative approaches to control conditions and costs. It is estimated that 171 million Americans will be living with one or more chronic conditions by the year 2020.[1] Case management is a program provided to individuals at various stages of their chronic conditions and assist in the management of the diseases. Qualification for the program is typically predetermined by an individual’s health insurance provider or by the employer. While case management is a great and needed service, traditional “call-at-home” programs are expensive and result in low engagement. One study conducted by The American Journal of Managed Care, which interviewed 70 health plans, found that plans have difficulty engaging members.[2] Below are five problems and considerations on how case management programs could improve results:

1. Low patient engagement

There is mixed feeling when discussing incentives. Does an extrinsic motivator result in intrinsic motivation? Questions related to the sustainability of the incentive and continued behavior change are concerns that frequently surface. However, if incentives are equitable and meaningful, they could engage individuals who may not have considered participation. 

The Fix: Carefully consider patient motivators and personalize incentives.

2. Ineffective communication

Case management programs need to consider integrating technology to not only engage participants but also lower costs. One study found that plans reported challenges contacting members due to missing or inaccurate phone numbers (Rand, 2015). A study conducted by Villagra and Ahmed, found that incorporating remote monitoring, in addition to phone and internet resources, lowered healthcare expenditure by an estimated $137/month[3]

The Fix: Keep patient communication data up to date. Consider the mode of communication most effective for individual patients.

Learn how Nokia's remote patient monitoring platform, Nokia Patient Care is connecting doctors to patients on a personal level

3. Integrate case managers into the provider site

Primary Care Homes have struggled in the past to manage the needs of patients with chronic conditions. Now, many have embraced the model of embedding a case manager into the provider site. This process eliminates the patient having to wait for or seek out his/her case manager and creates a team-based approach. One health plan saw a 20% reduction in readmissions by moving their case managers to primary care settings.[4]

The Fix: Keep case managers close to the patients that need them the most.

4. Technological gaps between care platforms

An individual with multiple chronic conditions may have many providers on their care team. It is critical that all team members are kept abreast of interactions. Case management portals must be integrated with other portals and systems to ensure proper care coordination.

The Fix: Continue investing in technologies that integrate seamlessly into the hospital environment.

5. Broken "one-size-fits-all" approach

Recent trends have focused on disease-specific programs vs general chronic condition management. This allows case managers to apply disease-specific solutions tailored to participant’s specific needs.

The Fix: Develop and modify care plans on an individual basis. 

Case management serves as a solution for many of the issues we see arise around people with chronic conditions, but the system as a whole is not without flaws. By paying more attention to the individual and smoothing out pain points in the care delivery process, case management initiatives can begin to provide a more robust solution to managing chronic conditions.

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[1]Mattke, Soeren, Tewodaj Mengistu, Lisa Klautzer, Elizabeth M. Sloss, and Robert H. Brook. Improving Care for Chronic Conditions: Current Practices and Future Trends in Health Plan Programs. Santa Monica, CA: RAND Corporation, 2015. https://www.rand.org/pubs/research_reports/RR393.html.

[2]Mattke, Soeren. “Results From a National Survey on Chronic Care Management by Health Plans.” The American Journal of Managed Care, 21 Mar. 2015, www.ajmc.com/journals/issue/2015/2015-vol21-n5/results-from-a-national-survey-on-chronic-care-management-by-health-plans.

[3] Avery G, Cook D, Talens S. The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures. Population Health Management. 2016;19(3):156-162. doi:10.1089/pop.2015.0049.

[4] Diamond, F. (2011, November 6). Geisinger’s Embedded Nurses Improve Transitions. Retrieved February 28, 2018, from https://www.managedcaremag.com/archives/2011/4/geisingers-embedded-nurses-improve-transitions

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