How care management can drive success in value-based healthcare

Kevin Ban, MD, chief medical officer of athenahealth, gave a presentation at the Becker's Hospital Review 6th Annual CEO + CFO Roundtable Nov. 14 titled "Unleashing the Power of Care Management: Trends and Best Practices to Succeed with Care Management in a World of Value-Based Care."

Value-based care emerged at the forefront of care redesign discussions when the ACA passed in 2010. Healthcare providers now have the tools and incentive to collect, normalize and analyze population health data to address problems in care management at the episode-of-care level. This presents ample opportunity to improve care management for patients with chronic conditions and multiple medical problems.

"Navigating a very complicated healthcare system, like the one we have, when you have multiple chronic conditions can be daunting, so we're turning to care management," said Dr. Ban. Athenahealth is working with healthcare partners across the country to manage care coordination. While care coordination isn't a population health strategy, it's a fundamental aspect of overall population health and allows organizations to shift their focus from a "diagnose-and-treat" mentality to optimize what happens between episodes of care. In many cases, this means addressing social and wellness aspects of patients' lives outside the healthcare system, such as:

• Patient adherence to medication protocol
• Patient access to healthy food
• Patient's housing situation

Care coordinators can help patients navigate the healthcare system as well as social determinants that affect their health. "There seems to be no doubt that patients do better with a care management plan and with a care manager than without it," said Dr. Ban. Studies show care coordinators who drive appropriate ED utilization can reduce admissions and readmission, reduce the number of medications patients take and ensure patients understand their care plan.

"Patients really feel a connection to their care manager and health coach, they feel like in a difficult and complicated system they are navigating with a trusted healthcare provider, which is a great feeling," said Dr. Ban.

The transition to value-based care also moves organizations closer to precision medicine; data-driven technology can help drive individualized care that optimizes treatment for each patient.

"Precision medicine will be boots on the ground care management," said Dr. Ban. "That's what precision medicine will look like. This will take into account who you are, what you want, what your medical history is, what the literature says, what the payer says, and they'll put it all together for you. For me, as I look down the road, that's care management of the future."

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