A study by Mass General Brigham suggests a new framework health systems can use to improve care management and advance value-based care.
The commentary, published in JAMA Health Forum, outlines some of the drawbacks of care management programs and proposes a new framework.
"As [care management] programs proliferate in number and specialization, the field of care management is increasingly at risk of fragmentation, inefficiency and failure to meet the core needs of the patient," the study authors wrote. "Given that the top 5 percent of patients incurring the highest costs account for half of all U.S. healthcare spending, focusing on patients deemed high risk (ie, outliers) suggests an efficient way to control costs. However, beyond addressing utilization and cost, care management can improve health outcomes by optimizing clinical care and addressing the relevant social determinants of health for a given patient."
The key challenges identified were:
- Unclear value proposition
- A focus on system- vs. patient-centered outcomes
- Increased specialization by private and public entrants the create care fragmentation
- Lack of coordination among health and social services
Researchers also identified five components of a patient-centered program:
- Treats people as multidimensional and not static in needs
- Offers a continuum of support matched to their needs
- Requires services to integrate and coordinate efforts to determine their role on the continuum
- Commits to rigorous regular evaluation of broad program effectiveness
- Redefines value from a person-centered and health equity-based perspective
"To promote patient-centered care management, health systems can benefit from providing a patient-tailored continuum of care management offerings and better understanding the care management ecosystem available to patients via payers, community-based organizations and other sources. Policymakers have a similar responsibility and opportunity to develop incentives to address worsening fragmentation in this field and to promote a more holistic, equitable, and patient-centered approach to care management aligned with value-based care," the authors wrote.