How Gov Can Deliver Better Care

According to the Congressional Budget Office, spending on health accounts for nearly 27 percent of the US federal budget. On the state level, a similarly large portion of budgets is dedicated to Medicaid spending.

While those staggering numbers highlight a large expense for government, they also represent a large opportunity to cut costs. And according to a recent IBM report, those savings can be accrued without depreciating the value of care patients receive. In fact, by applying new care management processes backed by innovative technology, government could actually improve patient outcomes.

What does that care management process look like? According to IBM, there are five fundamental steps to a robust care program, no matter what medical need is being met. These five steps are:

1. Identify: The social determinants of health are identified and factored into a patient’s care plan.
2. Assess: The patient’s needs are quantified to determine similarity to other clients, as well as potential costs and risks.
3. Respond: The assessment is used to determine eligibility and entitlement to benefits and services. Then, a care plan is created that addresses the severity of patient needs.
4. Manage: A single care coordinator manages the patient’s entire care plan.
5. Measure: Outcomes are managed at the individual, program, and organizational levels.

To effectively navigate this multi-step process, care providers must be able to collaborate in a single workflow. Otherwise, vital information from one stage may not be effectively translated into the next. That causes process redundancies for providers who have to recollect information. In worse-case scenarios, these failures in knowledge-transfer can also lead to patients missing vital care.

To avoid these pitfalls, government care providers must deploy common workflows and coordinate across care environments. In many cases, this will require the use of collaborative technologies to manage these workflows and facilitate communication.

When effectively deployed, this technology-driven integrated care management can have significant impact on the bottom line of government healthcare services. Because work is automated and coordinated, caregivers and case workers can spend less time on administrative redundancies and more time on those patients in greatest need of assistance. In some cases, these healthcare management solutions can even enable patients to execute or monitor their own routine care. This efficiency cuts operational costs in the short-term, and it also delivers long-term benefits of better health outcomes for patients.

Coordinated care in the real world
In theory, this idea of integrated, technology-driven healthcare management sounds great for providers and patients alike. But can these anticipated results be delivered on the ground? In 2013, IBM partnered with the New York Department of Health to prove the value of this holistic care management approach while improving the state’s Medicaid system.

The state of New York received ACA funding that year with the mandate to create a better care management program for its high-cost, high risk Medicaid members. Given that New York has approximately 5.8 million people enrolled in its Medicaid program, that was no small task. Additionally, the program was required to support a diverse range of medical needs and services, including:

• Referrals to community and social support services
• The use of health IT to link providers and tools across environments and stages of care
• Transitional care and followups from inpatient to outpatient care settings
• General health promotion activities

IBM worked with the Department of Health, as well as state housing, mental health, and managed care facilities, to connected these myriad services into a streamlined process, complete with defined use cases and supporting workflows. To house these new care management plans and facilitate coordination across citizens, families, healthcare providers, and community services, they also created a health homes analytics portal.

Today, that portal is used across Medicaid programs in the state to manage the lifecycle of patient care. Because it connects patients to the services they need, outcomes have improved and care costs for patients have decreased. What’s more, state providers are also seeing cost-savings, as they can more efficiently collaborate across settings to deliver the best and most needed care.

The future of care management
New York’s story is just one example of how integrated care management can improve care while reducing government spend on healthcare. Other municipalities including Camden, New Jersey and San Diego County have also reaped significant rewards from re-imagining the way they deliver coordinated care to their patients. To learn more about your healthcare agency can follow their examples to provide better, connected care without straining your budget, be sure to read IBM’s report Coordinating Health and Human Services.

Photo Credit: Flickr/Shawn Campbell