Targeted case management (TCM) has been a staple of services to consumers with complex conditions. The Centers for Medicare & Medicaid Services’ (CMS) definition for case management includes “services that assist eligible individuals to gain access to needed medical, social, educational, and other services.” And, it has been widely used in community-based settings (see Technical Assistance Tool: Optional State Plan Case Management). In 2015, states spent more than $2.6 billion on traditional case management services for the population receiving long-term services and supports (see Medicaid Expenditures For Long-Term Services & Supports (LTSS) In FY 2015).
But fee-for-service targeted case management as we know it is going away—or at least being repackaged. Since the advent of the Patient Protection and Affordable Care Act (PPACA), we have seen the rise of health homes in Medicaid, which provide a per member, per month payment to provider organizations to provide whole person care coordination. The rates for these services vary widely by state from a maximum payment of $76.71 in Iowa to a minimum payment of $389 in the District of Columbia (see U.S. Medicaid Health Home Market: The 2016 OPEN MINDS Update). Now payers and health plans of all types are moving to coordinated care models such as medical homes and health homes that are capitated. The challenge for provider organizations is how to provide the wealth of face-to-face services needed by consumers with the most complex needs—and use less expensive care coordination for less needy consumers. That’s where technology comes into play.
The impact of technology on care management was the focus of The 2017 OPEN MINDS Technology & Informatics Institute session, Information Exchange & Tech Innovation: How Technology Is Changing Case Management, featuring Virginia Matthews, Project Manager, MAXIMUS, and Luke Crabtree, Chief Executive Officer, Project Transition. Ms. Matthews shared a program for California health care professionals with addictions at-risk of losing their license; Mr. Crabtree discussed their Tennessee-based care coordination program for consumers with I/DD. What did their discussion tell us about the changing role of care management? I took away two big themes: First, technology shifts more care management to consumers; and second, technology allows for real-time correction of problems.
Technology shifts more care management to consumers — Consumers who are engaged in their care use fewer resources and have generally better outcomes (see Consumer Satisfaction, Consumer Engagement & Shared Decisionmaking and Making Consumer Engagement A Reality). And the role of case managers is enhanced by an engaged consumer – and technology makes this step towards greater self-management possible by educating consumers about their health issues, providing them with access to on-demand resources, and giving them the tools they need to participate in decisionmaking about their care.
An example of this is to provide consumers with an app that can help them manage their own health goals. As Ms. Matthews explained in the session, it is one of the main goals of their program to teach consumers how to manage their own care over the course of three-to-five years. For her organization, providing consumers with an app that gives information about access to community resources, puts many of their forms and documents in one place, and allows them to contact their care manager directly, is a first step to engaging them in their care.
Technology allows for real-time correction of problems — Technology enables real-time monitoring of consumers. This consumer data can be shared with the consumers themselves, front-line care managers in the field, and provider organization managers and executives. The data can be in the form of a real-time dashboard, an alert system, or a daily progress report. The goal of these systems is to give the people managing care the data they need to act quickly to correct problems and resolve issues before they escalate and consumers end up going to the emergency room or needing an inpatient intervention (see Understand Your Data, Make Decisions Quickly & Fail Fast and What To Do If You Don’t Have ‘Big Data’ – Making The Most Of ‘Little Data’).
An example? A real-time dashboard for clinicians that allows them to review specific metrics on the consumers they are serving, and notifies them if a consumer isn’t meeting targets. Ms. Matthews noted that their app has a daily check-in function for consumers that notifies a care manager immediately if a consumer posts a low score for intervention. This enables care managers the data they need in a simple dashboard format and they can drill down to problems in their area immediately rather than sifting through tons of spreadsheets and paperwork.
It’s unlikely that technology in case management is a phase. We can expect that as technology improves and becomes more widespread, the facets and expectations of case management will change. For more on incorporating technology into your organization’s strategy, join us in Clearwater Beach, Florida in February for our special session, Leveraging Technology For Competitive Advantage: An OPEN MINDS Seminar On Best Practice Technology Implementation, at The 2018 OPEN MINDS Performance Management Institute.