Developing Care Management Programs to Serve High-Need, High-Cost Populations

February 2016

As the health care system shifts from a fee-for-service structure to value-based payment programs, it’s important to offer appropriate services across the continuum of care. This resource reviews lessons learned and opportunities for improvement. It also includes detailed case studies.

  • Forming meaningful partnerships with patients and family caregivers occurs not just at the point of care, but also at the system design level and at the community level.
  • Care management programs should include processes for evaluating patient-reported outcomes (PROs). PROs provide information such as health status and behavior, severity of pain, physical functioning, quality of life, etc.
  • Programs should collect information on low- and no-value care in order to reduce waste, improve care, and lower costs.
  • There is no one-size-fits-all approach for care management.
  • Successful care management programs respond to the specific needs of the patient. Programs and plans should be continuously assessed and adapted to the ever-changing needs of the patient.
  • Providers who are philosophically aligned with the program, have a track record in improvement, and have a financial stake in the program’s success may provide the strongest leadership.
  • For patients, education and peer support are critical.
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