How to take a performance-driven approach to care management

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The U.S. Centers for Medicare and Medicaid Services’ (CMS) announcement of the Making Care Primary (MCP) program cements primary care as a key component of value-based care (VBC). For patients in the eight states where the pilot is launching in July 2024, there’s a distinct possibility of improved health outcomes. Primary care physicians participating in Making Care Primary will see enhanced value-based care (VBC) payment models, tools to form partnerships with specialists, and strengthened community connections to address patients’ medical and health-related social needs (HRSNs), like housing and nutrition.

In short, CMS’ Making Care Primary program incentivizes a connection between the physical and the mental, advocating for care management programs that treat the patient as a whole – not just their discrete diagnoses. To perform successfully under this new model, sophisticated technology is key, especially for risk-bearing organizations looking to excel at population health management.

Care management: a challenge and a necessity

Kate Behan, MD, FACP
_Arcadia

Care management programs have always been challenging to establish and run. Amid all the moving parts that make a care management program succeed, there are just as many barriers, such as:

1. The need to use multiple data sets and sources, which leads to time-consuming, repetitive manual processes, often hindering a team’s effectiveness and efficiency.
2. A lack of clarity around which populations and programs to prioritize.
3. The inability to predict who will benefit most from care management.
4. The inability to predict and measure potential return on investment (ROI), and subsequently sustain funding for programs.
5. Difficulty integrating various technology resources at the point of care so that they serve both the care team and the patient.

These issues have clear correlatives to other common challenges that are widely acknowledged within health care, like staffing and resources (and the ensuing burnout). They also point to the frustrating challenge of mounting high-quality, cost-effective interventions with limited time or support.

Organizations don’t have the luxury of ignoring these hurdles, but often, it’s difficult to know just where to start, much less how to measure ROI. Fortunately, available technology can help transform an abundance of data into a clear, actionable view of your patient population and business goals.

Technology and analytics are critical for success in VBC and beyond

Increasingly, health care groups recognize that tools that support strong, data-informed decisions are critical to their success, both at the point of care and in care redesign. In a recent survey commissioned by Arcadia in partnership with HIMSS, the Healthcare Information and Management Systems Society, 93% of health care leaders agreed that quality data is critical to performance.

High-quality, timely analytics and automation tools can:

1. Identify and stratify patients with the most urgent needs.
2. Estimate costs of interventions and potential savings to allocate resources effectively.
3. Create targeted and successful patient engagement programs.
4. Make a care team’s day-to-day routine easier and more seamless.
5. Measure processes and impact to promote continuous improvement.

In my role as chief medical officer, I've witnessed a number of organizations successfully adopt a data- and automation-centric strategy – including an accountable care organization in the Northeast that managed to service three times more patients with the same care management staff.

In addition to impacting operations, technology is also impacting patients. A population health director at another ACO recently shared how a patient didn't know where to turn for help and was praying for assistance. It was at that moment that a member of her team called as part of a care management program, providing the support the patient needed by leveraging technology to identify the next best action.

Improved performance is made possible by algorithms that automate the capture, clean-up, and distillation of important health care data, shedding light not just on the present but what interventions might drive a healthier future.

Data to drive performance and weather a health care changing landscape

Technology enables incredible change in the health care industry, but it’s also accompanied by immense pressure. Between digital innovation and payment reform, organizations are in the midst of a dizzying transition, and data analytics are a foothold to climb the steep path ahead.

To succeed, there’s an acute need for organizations to lean into new technological tools, reimagining the way they manage and deliver care and achieving sustainable financial performance in the process. In practice, this necessitates a detailed roadmap for streamlined data collection, storage, sharing, and analysis.

Ultimately, data and technology are the currency that will enable VBC organizations – including those who participate in the Making Care Primary initiative – to deliver high-quality care and do it efficiently, generating revenue and thriving in an evolving climate. Both health care organizations and patients benefit when data enables the efficient alignment of resources, helping providers meet and identify needs and deliver care to those who need it most.

Kate Behan, MD, FACP, is the chief medical officer at Arcadia, a leading data analytics platform for healthcare, where she applies a clinical perspective to the design and implementation of strategies that enable health care organizations to succeed in value-based care. In addition to serving as a strategic advisor to physician leaders at Arcadia’s clients, she provides clinical input into the development of Arcadia’s technology and service programs.