In an era where medicine is highly specialized and different specialties are involved in the care of a patient, intelligent use of information technology is essential to help providers, payers and patients achieve better care management outcomes while simultaneously improving cost and quality of care.

While some entities, such as the Department of Veterans Affairs, have implemented solutions where patients have the ability to view their personal health records online and offline, the majority of the healthcare industry continues to face multiple challenges while implementing care management processes. Care management for large, diverse populations is highly complex and subjective, largely because needs vary for each patient and encounters may span across multiple care settings and plans.

Although a large proportion of health information today is captured electronically, integrated data around patients and their underlying disorders is often not available to providers at the point of care. However, efforts to code clinical content with standard terminology has, to some extent, helped streamline information across applications. There is also a lack of alignment between payers and providers in regards to cost of care management services and shared risk arrangements, leading to sub-optimal care quality.

How organizations manage their healthcare data, and what they use this data for, therefore becomes extremely critical to the success of these programs. While technology plays a very important role in areas like decision support, care coordination and population health management, providers and payers are still faced with the challenge of managing both complex people and process challenges.

Effective use of patient data

Patient data adds value across multiple areas such as decision support, planned interventions and medical reconciliation. Such examples include:

• Using CPOE Based Order Sets: Effective clinical decision support tools contained within an order set can help enforce the use of quality measures or meaningful use criteria by providers. An example would be the use of a venous thromboembolism (VTE) risk assessment and subsequent prophylaxis for high risk patients embedded within an order set. Monitoring the prophylaxis regimen based on the VTE risk score can help reduce incidence of venous thrombosis.
• Clinical Information Exchange: Effective care coordination requires healthcare data to flow seamlessly across all parts of the healthcare ecosystem, including providers, payers and consumers. By aligning incentives, all parties can reduce costs and improve quality of care. By leveraging health information exchanges across radiology, laboratory, perioperative, inpatient and outpatient applications, healthcare organizations have the ability to access patient data in a timely and secure fashion.
• Medical Reconciliation: This feature is commonly available in electronic health records (EHRs) and can play a very important role in preventing adverse drug reactions. For example, the use of over-the-counter (OTC) medications like acetaminophen may not get recorded in an EHR, but can be retrieved from the pharmacy or the medication management application. This is extremely critical information for a physician, given the hepatotoxic profile of the drug.
• Patient Registries: A patient registry fed with data from EHR applications can show the treatment prescribed to patients and identify care gaps, based on evidence-based guidelines. Care management programs can use this kind of analysis to highlight areas of improvement, thus positively impacting cost and quality of care.

Promoting patient engagement

Patient education plays a very important role in effective care management. Patients who are actively focused on learning more about their conditions are more likely to participate in initiatives that promote preventive steps and healthy behaviour. The use of patient portals, for instance, allow patients to have anytime, anywhere access to their medical records, and the ability to schedule appointments, request medication reconciliation, etc.

Processes such as discharge management and preventive care can also provide strong opportunities to increase patient participation. Such processes play a crucial role in keeping readmissions and acute care costs to a minimum. Automated alerts informing patients to make appointments or follow up on lab visits can help prevent potential acute and chronic conditions.

Patients today are increasingly using consumer devices and mobile apps to store and monitor their health parameters. Wearable devices have the ability to change the way health data is collected and managed, and care management processes will soon need to incorporate consumer technology to enhance patient engagement and self management.

Managing Stakeholder Expectations

To drive a sustainable care management program, it is important to demonstrate value to key stakeholders including providers, payers and patients. However, the definition of value differs from one entity to another. For instance, providers and payers often do not see eye to eye on issues such as risk sharing and care management goals. It is essential to build consensus on many of these issues and agree on clearly defined goals around care objectives, processes and costs.

Addressing issues around provider and payer expectations could lead to significant advantages for the healthcare industry as a whole. According to the Center for Disease Control and Prevention, the government spends nearly three-fourths of its total healthcare expenditure on chronic disease, an area where care management programs can make a large impact. A concerted effort from all major stakeholders to streamline care management objectives and processes would have a very large impact on healthcare cost and quality.