What is a Care Management System?

Some time back, I came across an article titled “The Next Major Healthcare Product – Care Management System” written by John Lynn of Healthcarescene.com. The article discussed that after the Practice Management Systems (PMS) and the Electronic Health Record (EHR), the next major healthcare product is the Care Management System (CMS). John made the point that the PMS managed the Practice (i.e., Billing), the EHR stored the records electronically, and that the CMS was going to be centered on the Patient and the care that the Patient receives.

So, what is a care management system? In previous years, traditional care management focused on processes related to the period of time that patients received treatment at a hospital. These old-school care management systems typically (a) focused on documenting the care provided to the patient in the hospital only, i.e., did not extend across the care continuum; (b) did not facilitate collaboration between the extended care team and the patient; (c) did not allow patient-generated data to be incorporated into the system; and (d) did not enable registries and population health.

Given the emphasis on patient-centric and value-based healthcare models, the argument in the article made sense to me. By 2018, 50% of Medicare payments will be paid via alternative payments models such as ACOs or bundled payment arrangements, as well as 90% of traditional Medicare payments will be tied to quality- or value-based programs such as Hospital Value Based Purchasing and the Hospital Re-admissions Reduction Program. Succeeding in these new delivery and reimbursement models will require better capabilities from Providers (Physicians and Hospitals) for engaging Patients and making them active participants in their care management. The new generation care management system will need to include patients in the management of care, enable the entire care team (PCP, Specialists, Hospital physicians and nurses, Social Worker, Nutritionist, Behavior Health Counselor, Discharge Coordinator etc.) to track patient health and collaborate, and engage patients outside the healthcare facility, not just inside.

Several CMS solutions are being developed by digital health startups to meet the above-mentioned objectives. Patientriciti is one of these companies. In the next few articles, I will share our point-of-view on the attributes and capabilities of a robust CMS system.

My firm, Patientriciti (www.patientriciti.com), has a multi-modal, multi-lingual, patient engagement and care management solution which helps Providers and Health Systems reach and engage with different segments of the population in a personalized way to affect sustained behavior change. Email info@patientriciti.com if you are interested in more information.