Healthcare coordination can overwhelm even the most knowledgeable patients, especially if they have a complex condition or treatment plan, as seen with patients who have cancer, heart disease and other serious illnesses. Matters are even worse for people from marginalized communities who have a hard time finding providers or obtaining insurance, or they may experience other issues with access to care and social determinants of health (SDOH).
Care management has the power to alleviate many of these issues. Simply stated, care management is when a healthcare professional steps in to coordinate the care and support services a patient needs. More involved forms of care management reduce substance use and emergency room visits, while also helping patients meet their financial needs. It might also be the key to improving health equity.
Patients with the most complex health conditions are usually also among those with many providers, medications, and treatments to keep track of. Care managers help take some of the mental load of complicated health conditions by working with a patient’s providers to schedule appointments and assist with treatment plan adherence. The benefit of this arrangement is fourfold:
- One person bears the responsibility for scheduling all of the patient’s appointments so they don’t conflict with one another.
- Care managers engage with patients on a regular basis, making it less likely for them to miss an appointment or forget to take their medications.
- Patients are more engaged in their own care because the care manager checks in frequently to assess their needs and answer questions.
- Care managers consider and address SDOH as part of the patient’s care plan in order to improve patient outcomes.
Facilitating Effective Communication Between Providers and the Patient
A common complaint from both providers and patients is that healthcare is often siloed. Doctors from separate departments don’t always have the opportunity to collaborate on patient care, especially when they have a full patient load that keeps them busy.
Care managers step in to facilitate meaningful communication between providers, as well as the patient. Instead of leaving the patient to speak in circles with doctors and other professionals who are pressed for time, care managers discuss needs and concerns with the patient themselves.
Since care managers are often registered nurses, they are qualified to assist patients with basic or routine concerns. They can triage their needs and escalate a concern or question to the patient’s doctor as necessary, reducing provider workloads and increasing patient satisfaction along the way
Coordinating Healthcare Needs in a Holistic Fashion
Having one person primarily responsible for a patient’s case gives patients a more holistic healthcare experience. Care managers have a good grasp on a patient’s total health. Through conversations with the patient, they can quickly assess if a patient needs to be seen earlier, requires a referral to an additional provider, or would benefit from mental health services to cope with the realities of their complex health status.
This isn’t limited to healthcare alone. It also provides the opportunity for case managers to learn about a patient’s living situation, access to food, employment status and more. Together, these things make up SDOH which influence many health outcomes.
Connecting Patients With Services to Address SDOH
SDOH influences more than half of health outcomes—in fact, estimates are nearly 60%. This means they can be more influential than clinical care, especially among patients who lack basic social needs. Connecting patients to services and community organizations that provide access to healthy meals, housing, reliable transportation and other necessary SDOH interventions has a significant impact on both their quality of life and health outcomes.
Social safety nets that address SDOH are underutilized in many areas. This is in part due to underutilization of screening practices for these social needs. There’s an opportunity for care managers to prioritize patients’ SDOH and assist them. They can connect them to programs that help with housing, food security, job placement, transportation to healthcare appointments, and more. Addressing these needs helps improve patient outcomes and reduce healthcare disparities among those from marginalized communities and/or with lower socioeconomic status.
Some care management solutions make it easier to do this by providing access to a consolidated directory of local and national service providers and community-based organizations that help support patients and their families with SDOH needs.
Engaging and Empowering Patients in Their Own Care
Care management requires regular and ongoing contact with patients for the duration of their treatment. This puts care managers in a unique position to develop rapport with patients that engages them in their own care. And with that rapport, patients may feel empowered to not only follow their care plan, but also to raise questions about any concerns they have.
Patients who are engaged in their own care experience better health outcomes. They also benefit from a sense of empowerment to make decisions that work best for their personal circumstances. Among certain patient populations, providers and case managers can increase engagement through a patient portal or mobile app. This also helps reduce patient visits and phone calls, freeing up time for both healthcare professionals and the patients they serve.
Benefits of care management are critical for patients of color and those with lower socioeconomic status. In many cases, care management reveals opportunities to improve quality of life and health outcomes by helping the most vulnerable patients get access to services and funding for unmet social needs—it goes far beyond assisting with appointments and has a direct impact on health equity.
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About The Author: Medecision
Medecision® is a digital care management company whose solutions and services are used by leading health plans and care delivery organizations to support more than 42 million people nationwide. Aerial™, a HITRUST CSF®-certified, SaaS solution from Medecision, seamlessly connects the healthcare ecosystem to powerful data and insights that drive meaningful consumer engagement while creating efficiencies to reduce costs and support effective care, case and utilization management. Aveus, our professional services division, helps business leaders solve complex challenges and drive better performance, leaving organizations more capable.
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