BLOG: Three keys lead to better care management

Those of us who work to improve patient care every day are focusing on a long-term question: How do we ensure that the system we are re-creating is as intelligent, efficient and effective as possible-especially as Medicaid covers more and more people?  

To get at some answers, here are a few case-study glimpses into today’s real world:

• 35-year-old man is diagnosed with diabetes. He only skims through the information his doctor gives him about the disease, and he takes his medication only sporadically because he doesn’t like its side effects; in fact, he doesn’t plan to refill the prescription.

• A 72-year-old woman is seeing a different physician for each of her many ailments. She is knowledgeable about her conditions and conscientiously takes her numerous medications, but there is no apparent coordination among her multiple doctors and pharmacies, so a few of the drugs are in the same category and there is a clear risk that some may interact negatively.

• A 47-year-old man with a history of myocardial infarction isn’t complying consistently with his treatment plan. He isn’t educated about available recovery and rehabilitation programs, and medications such as beta blockers, which could have helped him, haven’t been prescribed.

Because these patients also participated in a voluntary program, offered through their insurers, in which a “care manager” helped them to create individualized plans, they received the information, medication and coordinated services they needed to resolve their specific issues and get on a path toward better-and ultimately less-costly-long-term health.

Most Americans need help navigating their healthcare, however. That has always been a concern, and it could become a far bigger one as the number who likely will be covered by Medicaid programs burgeons.

What can we learn from the case studies above to inform best practices as the healthcare industry proceeds into the next chapter of its history? Here are just a few lessons to consider:

First, far more attention needs to be paid to patients who are “at the verge of risk.” Currently, Americans who are at high risk medically get the most attention, utilize the most resources, and are integral to driving up costs. We need to prevent this population from growing-and that means better-serving the millions of people like the three described above, those who will become high-risk unless we act methodically to help them.

Meghan Harris is chief operating officer of KEPRO, a quality improvement and care management organization.