Whitepaper number 2 10.15.15 Updated 2

Whitepaper number 2 10.15.15 Updated 2
F( THE FUTURE OF CARE MANAGEMENT:
WHAT’S YOUR GAME PLAN? October 2015
WHO OWNS CARE
MANGEMENT TODAY?
The ongoing shift from fee-for-service to value-based healthcare
reimbursement has catalyzed significant changes in care
management and care coordination, which are emerging as top
priorities for health plans as well as providers in various value-based
reimbursement contexts.
Health plans have historically led the vast majority of care
management initiatives, as they have had the infrastructure to
support large-scale programs in order to manage medical costs and
improve clinical outcomes in fee-for-service environments. In the
light of today’s growing number of risk-share and gain-share
relationships, however, ownership of care management can
sometimes be less clear-cut. Providers (who increasingly share the
financial benefits of successful care management) are beginning to
invest in their own programs. And while health plans still drive the
majority of care management, many plans aim to delegate at least
some of their programs to providers such as ACOs and PCMHs.
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THE QUESTION OF SHARED
OWNERSHIP
This changing healthcare landscape begs the question: Who is
responsible for care management?
For better or worse, it’s not always clear where programs like
chronic and transitional care management, case management, and
behavioral health management are suited to reside. And although
plans may express a desire to delegate care management to
providers, providers often aren’t equipped to take on this
responsibility. Plans and providers will ideally approach care
management collaboratively as to prevent high-risk patients from
falling through the tracks and improve patient compliance.
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5 PROFILES OF CARE
MANAGEMENT IN
TRANSITION While there’s no tried and true formula for delegating care
management responsibilities at this time, opportunities are
emerging for care management to become more aligned and
effective as plans and providers consolidate.
Wellframe has been working with a broad range of organizations
that provide care management services. Having observed these
organizations navigate common challenges, opportunities, and
strategies as they work to adapt to new clinical and financial
realities, we’ve highlighted 5 profiles of care management programs
in evolution:
1. Large state plan with a growing Medicare Advantage (MA) population This MA plan has provided care management to its highest risk
members for a long time. Now, it must reach a larger proportion of
members with its existing care team in order to sustain and improve
revenue through Five Star ratings. Its primary challenge is achieving
broader goals including clinical and financial risk management as
well as quality improvement without additional resources.
2. Small state health plan with predominantly
commercial business: differentiates on customer
service and affordability
Well over half of this state health plan’s business is full risk, while a
growing percentage entails risk-sharing with providers. This plan
aims to delegate care management to providers, but cannot do so in
the short term as many of its partnering providers don’t yet have
the infrastructure needed to take on care management
responsibilities. As a result, it must improve the efficiency and
effectiveness of its own program with modest FTE and
infrastructure investment.
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3. Large multi-practice physician organization
This organization is taking on risk from health plans in blocks of tens
of thousands of patients: first through gain-share, then risk-share,
then full capitation. The practice has a care management program in
place, but it’s limited in scope. To mitigate growing risk, this
physician organization needs services that accomplish more than
coordinating healthcare resources and scheduling follow-up
appointments. However, its desire to sustain longitudinal
relationships with patients can’t be realized without significant
investment in IT infrastructure, analytics, training, and workflow
development.
4. Medicaid managed care plan with significant
member growth
For the first time, this plan is integrating care management for
chronic disease and behavioral health in order to efficiently and
effectively support a new wave of vulnerable, transient, and hardto-reach members. The plan is looking to use digital tools—an
increasingly preferred channel for support and engagement among
lower income members with chronic care and behavioral health
needs—to extend the scope and effectiveness of its program.
5. Large state plan leading a patient-centered
medical home initiative with its provider network
This plan is sponsoring infrastructure and resources to in-network
providers who are incentivized to develop practices around
enhanced primary care, population health, and care management.
The health plan provides ongoing financial support to partner
practices, which do not have the means to invest in technological
infrastructure and service resources on their own. But despite
significant investment in information exchange, analytics, and
performance evaluation, this health plan remains challenged to scale
care management services effectively across its large geography
and patient population. Point of care patient contact alone does not
guarantee successful patient engagement at scale.
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COMMON CHALLENGES
AND OPPORTUNITIES
FACING CARE
MANAGEMENT TODAY
Two major obstacles to care management unite all five archetypes.
First, plans and providers have limited capacity to reach high-risk
patients, despite investment in nurse care managers. It’s not
uncommon for plans to reach less than 2% of their members, with
nurses touching one patient per hour for an average of just two
dozen patients per week. Patient contact is often scheduled once
every few months, resulting in disjointed, high friction relationships.
Secondly, sub-optimal engagement channels consistently inhibit
successful care management and expansion of care management
resources to include variety of healthcare professionals. Plans and
providers find landline telephone communication—standard practice
in most programs—particularly burdensome as fewer and fewer
patients own a landline telephone, let alone answer it. Also, patients
and care managers agree that connecting over landline phones can
be time-consuming and frustrating. In person visits, while they can
be quite valuable for clinicians and patients alike, are neither
scalable nor comprehensive, and little insight remains into the
patient’s health between visits. The third sub-optimal channel that
care managers frequently turn to, website portals and mailings, have
also failed to elicit sustained patient engagement.
At the same time, mobile device usage is on the rise across all
demographics. American adults are using smart phones to access
information and communicate in nearly every aspect of life and
work. On the back of widespread adoption, mobile is well positioned
to transform care management, as we know it. As the most intimate
and scalable channel for patient engagement that we’ve ever had,
mobile presents a clear opportunity to advance the care
management industry. Nonetheless, a minority of programs have
put mobile into practice effectively as of yet.
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EVOLVING CARE
MANAGEMENT WITH
WELLFRAME
That’s where Wellframe comes in. Our mobile platform for care
management helps all of the care management profiles described to
overcome challenges to patient engagement and improve patient
outcomes without additional investment in infrastructure or
headcount.
How it works.
The Wellframe application delivers a personalized care plan to
patients via a simple daily health checklist. As patients interact with
their care plans, the application captures information about
patient’s day-to-day progress and summarizes it in real-time on the
clinician’s dashboard, where the platform dynamically prioritizes
which patients need attention on any given day. Using these
insights, care managers can communicate directly with patients via
the app’s secure mobile messaging feature.
The impact of Wellframe.
Wellframe does not replace human care, but rather amplifies it. By
drastically reducing administrative burden, it empowers care
managers to operate closer to the top of their license, connecting
with patients in a more continuous and better informed manner. By
facilitating a more continuous connection, Wellframe helps patients
feel supported and care for. Lastly, it is designed to enhance the
effectiveness of care management by mitigating healthcare
utilization, increasing revenue through value-based payment, and
improving patient retention.
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Implementing Wellframe.
Delivering care management with Wellframe is easy, and getting
started doesn’t require replacing current systems or significant IT
investment. Our platform integrates with existing systems and can
be configured to meet the needs of diverse clinical programs.
Clinical programs are flexible and can be personalized and adapted
to patients’ holistic needs. Wellframe works closely alongside our
partners every step of the way. From implementation to analytics,
we provide the necessary support to engage patients and reach
their performance goals for each program. Request a demo.
Need amplified care?
If your organization sounds like one of the profiles we described, or
if you’re looking to extend the reach and effectiveness of care
management in general, we welcome the chance to learn more
about your goals and challenges. Please contact us today.
FOR MORE INFORMATION
Please Visit Our Website
http://www.wellframe.com/
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