Care Transformation Center Blog

Show care management value in a few key metrics

In part 1 of this series, we explained why physicians need a better understanding of the responsibilities of care managers, and showed you how to design an effective care management onboarding process for primary care clinics. But demonstrating care management value goes beyond onboarding. Care management programs can turn to data analysis and case review to both quantify and clarify their value.

Quantify value through surveys and claims data analysis

Many care management programs have found that collecting and presenting data that quantifies the value of care management is an effective way to draw attention to the benefits of care management.

Care coordination leaders at Gundersen Health System took a two-pronged approach, first surveying physicians to evaluate the impact of care coordination on their practice, and second analyzing health care utilization for patients under care coordination.

Over 40% of surveyed providers at Gundersen indicated that care coordination saved them at least 30 minutes per patient per month. These survey results showed the significant impact the program had on each physician’s practice.

Further, Gundersen’s care coordination leaders analyzed the impact their program had on health care utilization. When looking at the data, care coordination leaders found significant decreases in total patient charges in the 12 months post-enrollment. Interestingly, while total charges decreased, planned charges within the clinic setting increased, indicating increased utilization of primary care and preventive services.

Using survey and claims data, care coordination leaders were able to capture the value of care management for both physicians and patients.

Individualized case review can clarify value of care management

In some cases, reviewing individual patient cases with PCPs can illustrate the value of care management more vividly than data analysis. Care management program staff and/or medical leadership may seek to regularly review high-cost episodes to identify opportunities to reeducate PCPs on care management.

Cedars-Sinai Medical Network’s medical leadership team (medical directors and a quality nurse) reviews a subset of acute medical admissions on a daily basis to identify episodes that could have been prevented by care management interventions. When the team identifies a case, they email the patient’s PCP and explain how the patient can benefit from care management. The email also includes a suggestion to refer the patient to care management. If the patient needs immediate assistance, the team will email care management staff directly to make a referral. In cases where the team has concerns about quality of care, they may include a request for a formal response from the physician.

Organizations seeking to conduct individual case review can start by focusing on high-cost cases. Care management leaders can also analyze admissions to target those PCPs with high numbers of potential care management candidates.

For our back-of-the-envelope care management value calculator and a sample newsletter promoting patient testimonials about the benefit of care management, download Step 2 of our Improving PCP Referrals to Care Management toolkit.

And keep an eye out for part 3 of this series, when we'll show you how to optimize PCP referrals to your care management program through simple referral form redesign.

Have questions or comments? Please feel free to email me.

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