Care management has the potential to improve the health of a practice’s most at-risk patients while reducing costs. But how do you get started?
1. Identify what care management services you will provide. You'll need to consider the needs of your patient population as well as the tasks that are burdening you and your staff. These tasks could include coordinating and managing transitions of care (e.g., acute to post-acute care settings or acute to home), assessing and closing care gaps (preventive or related to social determinants of health), addressing complex patient needs, coordinating care among the patient's health care team, and navigating the patient through the complexities of the health care system.
2. Identify who can perform these functions. Many care management tasks require a staff member with a professional license, such as a licensed nurse or a licensed clinical social worker. Consider whether current staff members have the capacity to take on some of these tasks as you grow the program. If not, consider whether you can hire someone part-time at first. One primary care practice started its care management program by hiring a licensed clinical social worker. One year later, as the program and reimbursement grew, it was able to add another care manager, a registered nurse. The two care managers handle about 200 patients total.
3. Identify high-risk patients who could benefit from the program. The names of several patients might immediately come to mind as good candidates for care management because their care is complex or they are high risk. Nurses and other staff can help with the risk-stratification process, which sorts patients into risk levels and identifies those who require extra support.
4. Understand how you will pay for it. Some care management services can generate revenue right away, such as diabetes education, self-monitored blood pressure management, transitional care management, or chronic care management. Make sure your staff knows how to document and code for all billable care management services. If your practice participates in value-based care arrangements, make sure your staff are documenting and reporting the appropriate measures to assure shared savings.
To explore more about care management, check out these AAFP resources:
Read the full FPM article: “Care Management in the Real World: A Small, Private Practice's Journey.”
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