10 Capabilities of a Robust Care Management System

This article is Part 3 in a series of articles on Care Management Systems. . In Part 1 – What is a Care Management System? – I made the case that Care Management Systems are the next major healthcare product. A new generation of Care Management Systems is evolving driven by the patient-centric and value-based healthcare models. These new generation Care Management Systems include patients in the management of care, enable the entire care team to track patient health and collaborate, and engage patients outside the healthcare facility, not just inside. In Part 2, I shared my thoughts on the 5 Attributes of a Robust Care Management System. In this article, I share my point-of-view on the 10 capabilities of a robust Care Management System.

1. Patient Data Intake – Capability to import data from the EHR systems, Patient Portals, Practice Management systems, HRA data, or claims data from Payer systems. Data could include demographic data and clinical data to help identify target patients for specific care management programs, as well as patient preference data, if available, for personalized communication. Depending on the complexity of the programs, data intake could happen through secure file transfers or through integration with the data sources.

2. User and Role Management – Allows the Facility Administrator to create users for the platform and assign roles to these users based on the level of access needed for the user. This capability supports HIPAA compliance by allowing each user only the level of access they need to do their job. For example, a care manager could only be allowed to view and edit, but not import or export, information on the patients assigned to them. A robust solution will allow the creation of custom-defined roles that can specify level of access for each module of the solution.

3. Targeting Analytics – Functionality that allows the Administrator of the care management program to identify the target patients for each program based on demographic (age, gender, geography) or clinical (diagnosis code, Medication, Vitals, Lab Tests, etc.) characteristics. This enables the Provider to send customized content to the Patients that is relevant to them.

4. Program Development – Capability to quickly and easily create custom content (e.g., notifications, questionnaires) for each care management program. The functionality should allow the Program Administrator to either use content that has been previously developed by the Provider, or easily create new content using templates and libraries in the care management solution. A robust solution will allow easy customization of programs for different segments of the population based on preference or medical situation, e.g., email or text version for the tech-savvy population, Phone (Interactive voice response) version for the tech-challenged population, Spanish version for the Spanish-speaking population segment; different versions for patients with co-morbidities based on their care plan.

5. Program Administration – This capability allows the Program Administrator to personalize the engagement with the target patients by sending relevant content, in the preferred mode, in the preferred language, at the preferred time to each patient. A robust care management system will have the intelligence to automate the personalization based on expressed preferences.

6. Response Analytics – This capability tracks patient responses and enables the Provider to evaluate response rates by channel of communication, by geography, by age, gender, facility, provider, etc. This allows the Provider to optimize the channel mix and content to maximize the ROI of programs.

7. Survey Analytics & Alerts Management: This capability analyzes the patients’ survey responses to identify gaps in care and enables automated alerts to be generated based on the rules defined by the Provider. Alert management can be customized to alert different members of the care team (e.g., nurse, doctor, nutritionist, social worker) depending on the question and the response. The capability enables the Care team to view the alerts generated for each program and each patient, and allows them to manage large populations with exception-based interventions. A robust care management solution will provide follow-up alert-based interventions and educational components that support the patient through the program.

8. Rewards Management: The capability enables Providers to encourage Patients to change behavior and sustain behavior change by rewarding the desired behavior or activity, e.g., points for responding to a questionnaire, or taking their medication on time. Points can be collected and compared with others in the program (social competition), or converted to financial or other incentives, if desired. The rewards act as a positive reinforcement which increases engagement and makes the process of self-care management fun and rewarding.

9. Care Manager Dashboard and Workflow Tool: The Care Manager Dashboard and Workflow Tool enables Care Managers to access the platform to view information on patients assigned to them, view the programs their patients are participating in, track their responses, track alerts generated by their patients, and create notes and to-do lists for managing their patients’ health.

10. Backward Integration of patient-generated data: Capability to integrate relevant patient-generated data into the EHR system (e.g., Activity Data, Alerts) and the Patient Portals (e.g., Activity Data, Rewards Data). This enables integration with the clinical workflow and allows Physicians to see the patient-generated data within the EHR instead of having to refer to multiple systems.

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. Patientriciti’s solution is based on the 5 Attributes and 10 Capabilities that I have shared in these series of articles. Email info@patientriciti.com if you are interested in more information.