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Complex Care Management: Treating Patients With Complex Health Care Needs

The Center for Disease Control (CDC) has calculated that complex health problems account for approximately 90% of the USA’s healthcare expenditure. Complex care management is a delivery innovation for people afflicted with chronic illnesses or significant disabilities, and those requiring specialized care following hospitalization.

 

Complex care management programs are designed to assist patients and their support systems to manage medical conditions more effectively. They can significantly improve the quality of care and reduce costs, but take time to produce results.

 

How Patients Are Identified for Care Management

 

Both analytics and insight should be applied to identify those patients most likely to benefit from such offerings. Optimal evaluation leverages electronic health records (EHRs), claims history, and other data, in conjunction with the expertise and recommendations and recommendations of primary care providers and other clinicians. Most importantly, this hybrid approach must accommodate the self-reported views and engagement of patients themselves.

 

Benefits of Managing Patients with Care Management Software

 

Although most healthcare providers have some degree of computerized automation, fragmentation of information is still the major underlying problem in the healthcare industry. The new guiding model is an effective care management software (CMS) solution that provides a coordinated, comprehensive, continuously available record for every patient.

 

InfoMC introduces Incedo™, a versatile, rules-driven care platform that can administer cost-effective management of care for patients who have complex medical conditions. Seamlessly integrating all aspects of care management, from transitions of care to complex care, and care coordination, Incedo offers the following benefits:

 

Ease Overburdened Staff

 

US doctors spend up to two-thirds of their time doing paperwork rather than caring for their patients. Incedo is equipped with tools and workflows based on the special needs plan (SNP) model of care to reduce administrative burdens.

 

Practice Management

 

Using Incedo as your care management system releases you from the onerous tasks of everyday management operations and allows you to focus on delivering quality care to your patients.

 

Timely Patient Care

 

The success of many treatment guidelines is dependent on meeting very specific time frames during the delivery of healthcare services. Incedo enables scheduling timely appointments and alerts to maximize adherence to, and the success of, a patient’s treatment plan.

 

Organization

 

Organizational resilience depends on connection, transparency, and improvement. Incedo integrates patient records, payment details, and communication in a single platform, allowing you to analyze data and review your procedures rapidly.

 

Day-To-Day Operations

 

From recordkeeping to billing, keeping track of the day-to-day responsibilities of care management oversight can be demanding and possibly challenging. Incedo’s high level of process automation takes over most repetitive processes to handle your daily workload.

 

Quick Reimbursements

 

Features such as automated billing codes, rapid report production, and record maintenance mean quick reimbursements. Incedo’s cloud-based CMS ensures claims are approved without delay.

 

Care Management Improves Quality and Reduces Costs

 

Care management has come to the fore as a leading strategy for managing the health of populations. Patients with poor quality outcomes need frequent hospitalizations and emergency department visits. These high-cost services can indicate the inadequate quality of care.

 

Research has identified the care management scenarios that are most or least likely to result in improved quality and reduced costs:

  1. Hospital-to-home care management programs that target patients being discharged have had the most success in improving quality and reducing costs.
  2. Care management in primary care improves quality, but it may take time to see results.
  3. Commercial disease management vendors proclaim success, but their methodology and results may be biased. Evidence demonstrating quality improvement exceeds that of cost reduction.
  4. Research-based programs with specially trained care managers are generally well-funded by grants.
  5. Care management provided by multidisciplinary teams improves quality, but does not always reduce costs.
  6. Home-based care management programs have failed to demonstrate improved quality or lower costs.

 

Whatever the scenario, research consistently indicates that a two-pronged approach is required for success—staff implementation and care management software. Through integrated digital tools and shared data, Incedo makes the connections, reduces complexity, improves outcomes, and lowers costs.

 

Keys to Successful Care Management

 

Healthcare systems aspire towards the Triple Aim framework — optimized performance, improved care, and reduced costs. Care management programs showing success in these three areas have common characteristics:

 

Medical Records

 

Successful care management tracks all a patient’s information across the care spectrum and from multiple providers. EHRs are limited in tracking and inclusivity, but InfoMC’s Incedo provides detailed, integrated medical records.

 

Scheduling

 

Timely and convenient healthcare appointments improve outcomes and experience by alleviating delays. Incedo uses a rules-based approach to reduce wait times and ensure that the patient is seeing the right provider in the right place.

 

Patient Encounters

 

Effective care management uses patient encounter-based tracking among multiple providers, adjudication of services, and health outcomes reconciliation. The Incedo platform can coordinate, integrate and support all patient encounters.

 

Medical Billing

 

The Incedo medical management system specifically supports the Value-Based Care (VBC) payment model. Billing services, such as customer support, collections and follow-up, are guided by VBC to reduce health expenses and emphasize improved results.

 

Automatic Reminders

 

Effective care management ensures appropriate care without redundant or unnecessary procedures. Incedo’s utilization management software offers automatic care and payment reminders to improve revenue cycle management.

 

Security and Facility Requirements

 

Software solutions should provide secure access via a desktop, tablet, and/or smartphone, that accommodates third-party vendors. Incedo ensures that legal and regulatory requirements are met when dealing with sensitive, HIPAA-protected information.

 

Conclusion

 

Care management of patients with complex healthcare needs requires a strategy that aims to improve patient experience and treatment while lowering costs. Healthcare facilities and providers can achieve this by seeking a solution that offers data aggregation, identifies risks, employs predictive analytics, and can be configured for greater efficiency and unique needs.

 

At InfoMC, we strive to resolve the communication and collaboration challenges experienced within the healthcare industry. The primary goals of our Incedo Care Management Software are better, faster treatment, and heightened transparency. To make a meaningful difference to patients, providers, and payers, contact us here for more information.

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