Come join us for our next webinar, taking place April 25 at 1pm ET. This webinar will feature Matt Guldin, lead Care Management analyst, sharing insights from this expansive research undertaking into the current state of technology solutions for care management stakeholders.
Below is an excerpt from the introduction of the report to pique your interest (slated for release May 2nd):
As with VBC, commitment to the principles of evidence-based, personalized care management continues to be reaffirmed at industry events such as the HIMSS annual conference and in healthcare organization (HCO) and vendor mission statements and road maps. Reducing preventable readmissions has become a key forcing factor in the market. This year we find vendors and their solutions focusing on episodic care management activities, based primarily on 30- or 90-day programs established by evidence-based guidelines or defined by federal care quality measures.
This is in contrast to more open-ended longitudinal care coordination – which is better suited to address social determinants of health (SDoH), provide more personalized care plans, and achieve the sustained behavior change that can delay or even reverse the onset of preventable chronic conditions. It is also in contrast to such CMS programs as CPC+, which provides added incentives to physicians to address their chronic care patients. It appears that programs such as CPC+ have yet to fully capture physician attention.
In some ways, this focus on episodic care, which is often “cookbook”, represents a step backward. It emphasizes the various boxes that must be checked more so than the needs of an individual patient at that moment in time. Patient assessments, care plan templates, interventions, goals, educational materials, and performance metrics are often standardized. Interactions with patients after discharge or between appointments are limited. Many pertain to preexisting guidelines for interventions (mammograms, colonoscopies, flu shots, etc.) as opposed to more individualized needs. In short, episodic care management benefits HCOs more than it benefits patients.
At the same time, this step backward is pragmatic for two key reasons:
- A number of regulatory pressures – chiefly the penalties for hospital readmissions within 30 days, the bundled payment programs for hip and knee replacements, and the CPC+ program – have forced HCOs to narrow the focus of their care management program implementations. Under these regulations HCOs must manage costs related to individual episodes of care. With few exceptions, HCOs are not yet receiving government incentives to provide more longitudinal care.
- At a broader level, the longitudinal services of most benefit to patients – those that encourage self-sustained behavior change after a 30- or 90-day episodic care plan has been completed– are performed by a veritable army of holistic and community-based medical professionals. They will likely remain disconnected from the clinical care team, and the IT systems the care team uses, for at least the next three years. Although the status quo for processes such as referral management, transitions of care, and coordinating community-based services is hardly perfect – no other industry will make as many phone calls or send as many letters and faxes in 2017 –it is nonetheless better than shoehorning these processes into care management workflows that remain imperfect and still under development.
Amid this market shift, our research suggests that HCOs are beginning to realize two things:
- Care management is a far too intricate process, with far too many moving and interchangeable parts, to currently be addressed with an “all-in-one” solution from a single vendor.
- For all the value that a broad, collaborative health record (CHR) and a robust analytics algorithm can bring to care management, these features matter less than the ability to provide an evidence-based care plan, connect and engage care team members – including the patient, and monitor patients’ progress toward achieving care plan goals.
Register for the webinar here to learn more about the trends shaping the evolution of these solutions.