Care Management Imperatives are Driving Trends for 2022 and Beyond

Care management is on a trajectory of reinvention with a projected market value of $20B by 2023 and a 16.1 percent CAGR in 2020. Buoyed with pandemic-induced innovation, shifting consumer tech adoption, and facing value-based healthcare economics, here we share six imperatives that are driving trendlines for health plans and provider organizations.

CM Trends-Omnichannel

Imperative #1:
Omnichannel Care Management

While it’s clear that telehealth adoption grew exponentially in 2020, its effect on care management has opened up a new view of what’s possible. As a subset of telehealth, virtual care is projected to grow by 22 percent CAGR over the next five years, reaching $20B+ by 2027.

Today, care management leaders are looking beyond synchronous, video-focused interactions towards enabling longitudinal monitoring and targeted use of digital tools. For over 44K discharged patients, virtual was the only way to provide transitional care management last year. It was also instrumental in filling the gaps for patients facing greater risk from chronic diseases who couldn’t access their typical care routes.

Additionally, the use of remote patient monitoring (RPM) proved critical when vulnerable patients couldn’t be seen in-clinic. According to a Consumer Technology Association study, the benefits of using RPM are significant.

  • Improved patient outcomes by 49%
  • Improved compliance rates by 44%
  • Increased patients’ interest in their health by 42%

An omnichannel care foundation can open up new ways to engage consumers, mitigate gaps in care, achieve higher levels of adherence, and create better connections to the member’s community and wellness potential.

CM Trends-Holistic Heatlhcare

Imperative #2:
Care Management that is Holistic, Contextualized, and Personalized

Care management outreach is starting to increase focus on whole-person health, including mental health needs. Also, there’s a movement towards exception-based, personalized interventions in chronic care management, providing outreach when patient metrics go out of acceptable bounds. Rather than focus on which members are on the call list or who have upcoming appointments, outreach would be prioritized for those who need it now.

In addition to context and timing, care management programs are widening their scope to assess and address any identified behavioral health concerns. A recent consumer survey revealed that ~80 percent of respondents had experienced distress related to COVID-19, and more than 50 percent said they had felt anxious or depressed over the previous week. As care managers, nurse practitioners, and other care advocates engage members across channels, more programs are prioritizing mental health issues as a barrier to overall health goals.

CM Trends-Tine and Efficiency

Imperative #3:
Care Management is Desperate for Efficiency

The administrative burden on care teams, and subsequent turnover of care management employees, threaten program goals, decrease patient and program success while increasing cost. Time spent on data entry, miscommunication, and tracking down documentation keeps care managers from focusing on member interaction and engagement.

Automating workflows, deploying intelligent document processing (IDP), and implementing various intelligent automation technologies can streamline every administrative aspect of care management. From creating reminders, confirming appointments, and pulling patient lists to sending out reports to multiple care team members, automation demonstrates ROI through assisted and non-assisted, automated activity.

CM Trends-Home Health and Hospice

Imperative #4:
Broadening the Use of Care Management – Home Health and Hospice

Healthcare sub-sectors, like home health and hospice, are shifting their business models, making care management more critical for a wider group of patients.

Rebranding Hospice with Advanced Care Management

Hospice organizations and teams are tapping into ways to serve patients with life-limiting illnesses earlier, far before the last months or weeks of life. Some are redefining their place within a chronic care management journey, looking to create a seamless continuum of care in the home. Look for more around “advanced care management.”

More Shifts Towards Home Care

COVID-19 concerns will drive the shift from skilled nursing facilities towards more ways to use home health capabilities to support post-acute care or long-term care. As payers and providers reset their vision for care management and take on other trends mentioned here, greater emphasis will be placed on care delivered in the home with community and family support.

CM Trends-Tech Features

Imperative #5:
Care Management Tech Features that Meet Needs Now

Care management will continue to evolve, widen its application, and have new programmatic needs to meet patient health goals and business objectives. While many software solutions exist, as providers and payers reach further and further into innovative levers to support and guide patient behavior and decisions, new capabilities and data sources are required.

Currently, many solutions offer features embedded within the clinical workflow along with other foundation care management tools. However, there are no turnkey options that cover every use case, initiative, or innovative idea that an organization might want to test. According to a 2021 Chilmark report, seamlessly integrating new features and data sources can be achieved more easily through new interoperability rules, the growing adoption of APIs, data exchanges, and other technology accelerators.

Solutions will continue to evolve from straightforward data-aggregation and reporting to streamlining care management workflow through automating activity and simplifying next steps. The report highlighted the importance of “thinking beyond synchronous, video-focused terms for virtual care, instead of focusing on longitudinal monitoring and targeted use of tools.” 

CM Trends-ROI and Outcomes

Imperative #6:
Maximizing Care Management ROI and Outcomes

One recent study demonstrated that vulnerable populations under care management programs incur lower costs and experience better outcomes than those not enrolled in such programs. In 2020, three full-risk ACOs earned shared savings of ~$27M; $15M attributable to care management. Those care management programs spent an average of 22 percent less each month on healthcare resources.

50%+ health system CIOs say patient engagement is their #1 tech priority after tools to support the pandemic response.

Despite these improvements, care management programs need to demonstrate more ROI. Many health plans dedicate 10 percent or more of their administrative budget towards care management. However, they’ve traditionally felt they had more leverage through programs like utilization management or network management.

The following are emerging or novel ways that payers, providers, and other market entrants are using care management to improve health, control cost, and drive efficiency.

  • Digital Ecosystems – new companies or lines of business are being built solely on a digital-virtual business model
  • Prescribing Digital Therapeutics – the US may follow other countries where physicians are prescribing digital apps, resources, and services for greater empowerment towards health goals
  • Measurable Patient Engagement – capitalize on personalized channels to enhance just-in-time education and resources
  • Comorbidity Focus – there is increasing pressure to keep patient health stable by managing comorbidities better

What Did You Find Intriguing in the Care Management Trends?

These trends give a smattering of some of the latest research and news. Our healthcare services team can advise on how these trends could affect your care management programs, models, and technology needs.

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