While health agencies may differ on the finer points of what exactly constitutes a “social determinant of health," there is consensus among U.S. healthcare leaders regarding the need to improve the health of the populations they serve to ensure optimal outcomes and lower the overall cost of care. The urgency of this need has crystalized amid the spread of COVID-19, which has taken a harsher toll on America’s most-vulnerable populations.
Older adults and individuals of any age with underlying health issues (such as diabetes and asthma) are at greater risk of experiencing severe illness related to COVID-19. Additionally, emerging data from several states suggests the novel coronavirus may be disproportionately sickening black Americans, who are at greater risk of developing certain chronic health conditions and more frequently have limited access to healthcare services. In Illinois, for example, black Americans make up 15 percent of the population but, as of April 6, accounted for 29 percent of the state’s confirmed cases and 41 percent of the state’s COVID-19- related deaths, according to STAT.
The novel coronavirus is exacerbating many of the health disparities and demographic changes that have helped to fuel the nation’s healthcare cost crisis. America’s rising rates of chronic illness and aging population contribute to disproportionate levels of healthcare spending. Prior to the emergence of COVID-19, hospital and health system leaders well understood the need to drive down the overall cost of care and improve the health of populations. To improve care for patients and help their organizations navigate the fallout created by the current crisis, hospital and health system leaders can leverage sophisticated care management tactics and tools to help engage patients, improve outcomes and lower costs.
Becker’s recently spoke with two care management experts — Mary Bacaj, PhD, Head of Value-Based Care with healthcare services provider Conifer Health Solutions; and Bridget McKenzie, MSN, RN, Conifer’s Chief Nursing Officer and Vice President of Medical Management — about the value care management can bring to both providers and patients.
During the conversation, three essential components of effective care management emerged:
1. Identify: Successful care management begins with identifying the patients who will most benefit from having an assigned case manager to help them navigate their care. Patients with multiple comorbidities often require expensive treatments and are at risk of experiencing poor outcomes. Hospitals and health systems should leverage patient information to identify those complex cases that would most benefit from care management.
"You want to find those complex cases that are very likely to be high cost," Ms. McKenzie said. "You also want to
identify individuals who may benefit from some additional education, such as those with a new diagnosis or those
undergoing a complicated procedure."
2. Activate: For care management to be successful, patients must become active participants in their own care. This often requires a good bit of patient education and empowerment on behalf of providers. Case managers can help do both.
"For the average person, navigating the healthcare system is quite complicated — they may not know the right questions to ask, or they might be too embarrassed to ask any questions at all," Ms. Bacaj said. "Care managers are
there to break down those communication barriers and to get patients the help and information they need."
3. Measure: Tracking patient outcomes and measuring system wide progress on population health management goals is essential for calibrating care management strategies for short-, medium- and long-term success. Examples of measurements that can be helpful when examining care management programs include levels of medication adherence, resource utilization rates among patients and readmission rates among patient groups targeted for care management.
Overcome barriers with leadership and short-term wins
The involvement of respected clinical and operational leaders is crucial to the success of any care management team, according to Ms. McKenzie. “Care management is driven by leadership,” she said. “Having the right leaders in place is critical to the success of a care management program. Good care management programs bring together a great mix of talented leaders with varied experience."
In the beginning, leaders tasked with overseeing care management programs should target areas of care where the efforts can most quickly yield better outcomes. Targeting areas of greatest need at program onset is often more likely to lead to success and can help providers lay the groundwork for future program expansion.
"One of biggest mistakes we see is [health systems] not really drilling down on areas that will have the greatest immediate impact," Ms. Bacaj said. "From there you can expand the program to include efforts that will yield more
long-term benefits."
Hospital and health system leaders looking to improve the health of the communities they serve and safeguard their organization's fiscal health should consider launching a sophisticated care management strategy. In the wake of COVID-19, it will be time for healthcare organizations to truly move the needle on the social determinants of health.
"When it comes down to it, providers want to drive better outcomes," Ms. Bacaj said. “Care management is about investing resources where they’ll do the most good for patients."