Care Management Platform For Payers Aids In Improving Care Quality

Healthcare organizations are working around the clock to achieve the triple aim target by reforming the country's healthcare delivery system. They are working hard to successfully treat patient groups while lowering health risks and healthcare costs. Care Management Platform has emerged as a critical method of influencing the health of a specific population.

Care Management (CM) has developed as a dominant practice-based model for population health management. The Care Management Solution is based on the premise that appropriate interventions for people within a specific community would minimize health risks and lower healthcare costs.

Care Management Platform is an innovative collaborative, patient-centered monitoring system to helping the patient and their support networks in more effective manner to manage health conditions. It also includes the collaborative care procedures required to assist in the management of chronic diseases.

The three primary tactics for improving new or modified Care Management Solution are as follows: 

(1) Determine the population(s) having controllable risks.

(2) Align Care Management operations according to population's requirements 

(3) locate, train, and incorporate suitable employees to provide the required Care Management services. 

Care Management for Payers Can Improve Care Service Quality

Care Management for Payers helps to keep improving value assessment, prioritize the precise type of healthcare expenditure, and strengthen consumerism, while using operations, command, and control indicators.

According to the McKinsey researchers, care management entails payer-driven initiatives to connect with specific individuals and their care ecosystems in order to promote and facilitate high-value decisions.

The researchers urged payers to take four steps to accomplish this larger goal for care management.

1.    Payers must focus on high-potential sources of value

Care management can help payers increase revenue by enhancing clinical accuracy, addressing care gaps, boosting Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance, buy-ups, and user motivation and retention.

2.    Instead of focusing just on reducing total healthcare spending, payers should use care management to target clinically incorrect healthcare spending.

Payers can avert underfunding for individuals with high needs and invest heavily in those members with low needs by trying to reach the health inflection points, such as when a member is scheduled for surgery.

3.    Payers should accept consumerism. 

Improved member identity metrics, enhanced member contact details and channels, psychographic segmentation of members, and an interaction first approach can boost consumerism and improve a payer's care management strategy.

4.  Payers should use operational metrics and standards to oversee their care management systems.

Integrating staffing levels and best practices into operational processes can help payers improve their care management approach.