Care Management Brief and Handbook

The Care Management Handbook and Brief are the first in a new ACHP series on Health Plan Innovations in Patient Centered Care. The reports, press release and a Key Points document can be found in the attachments box on the right side of this page.

The issue:

• An estimated 75 percent of U.S. spending on health care goes to the treatment of patients with chronic diseases; an aging population means that this spending will only continue to grow. 
• A fragmented delivery system makes it difficult for many patients with chronic illnesses and complex needs to coordinate their care across multiple physicians, specialists, medications, or treatment options.

The solution:

• Care management — the coordination of care for patients with complex health care needs — has emerged as a way of improving quality of care for patients while reducing health care costs.
• The ACHP Care Management Brief and Handbook are comprehensive looks at how health plans can improve the patient experience through the use of care management nurses who work one-on-one with members. 

While there is no "one size-fits-all," we found some keys to success:

• Innovation. An important part of a care management program is flexibility and a willingness to adapt to meet changing needs of populations.
• Close partnerships. ACHP plans found that working closely with providers, patients, and community-based organizations – through frequent face-to-face encounters, provider/nurse “huddles” and extensive familiarity with community-based resources – help address all of a patient’s clinical and non-clinical needs.
• Payment Incentives. Payment incentives can be significant factors in the success of care management programs by encouraging hospitals and providers to partner in their implementation. Fee-for-service generally is not conducive to care management programs.

A section on Outcomes demonstrates plans’ successes in improving health outcomes among patients, reducing health care costs, and maintaining high satisfaction rates among members.

The bottom line:

• Community-based health plans are partnering with physicians, provider practices, and community organizations to improve care for patients living with chronic disease.
• Care management programs at the health plan level can focus on each patient holistically, including social and environmental influences of health, with a broad perspective on multiple conditions and complex needs.