Care Management of Patients with Complex Health Care Needs

Patients with complex health care needs account for a disproportionately high percentage of our nation's annual medical expenditures. They represent an opportunity to control the growth of health care costs by better managing their conditions, reducing hospitalizations and avoiding emergency department visits.

What is care management ?

Care management is a set of activities intended to improve patient care and reduce the need for medical services by enhancing coordination of care, eliminate duplication, and helping patients and caregivers more effectively manage health conditions. These efforts have demonstrated potential to improve quality and control costs for patients with complex conditions.

Does care management improve quality and reduce costs?

Patients who are experiencing poor quality outcomes often require more hospitalizations and emergency department visits. For this reason, utilization of high-cost services can be viewed as one marker of inadequate quality of care.

There is strong research evidence that care management improves quality, but the effect on cost reduction is less consistent. Hospital-to-home care management programs have had the most success in reducing costs.

Care management in primary care improves quality, but research indicates it may take time to see results.

What are the keys to successful care management?

In-person encounters: Person-to-person encounters, including home visits, are necessary features of effective care management. Care management relying solely on telephone encounters has not shown success.

Training and personnel: Programs with specially trained care managers who have a relatively low workload are most successful. Most care managers are registered nurses (RNs) who work as part of a multidisciplinary team.

Physician involvement: Placing care managers with physicians in primary care practices may help facilitate physician involvement.

Informal caregivers: Patients with complex health care needs, particularly those with physical or cognitive functional decline, often need the assistance of informal caregivers to actively participate in care management.

Coaching: Coaching involves teaching patients and their caregivers how to recognize early warning signs of worsening disease.

The Journal of Health Policy & Management is an open access scholarly periodical that publishes peer-reviewed scientific manuscripts. The journal also focusses on research areas such as Decision Science, Health Economics, Health Care Management and Public Health Policy.

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