Care management programs have been designed to help manage patient care and reduce costs. However, determining the return on investment (ROI) for these programs is not always clear. Risk-bearing entities and providers can take specific steps to improve their ROI and provide a better experience for individuals. In this blog post, we’ll explore three strategies that can help improve ROI and maximize the benefits of care management programs.
Strategy #1: Reduce Medical Costs
Reducing medical costs is a key goal of care management programs. By detecting and diagnosing preventable medical events early on, organizations can achieve immediate value. Care management programs can also help manage complex, high-risk, and rising-risk individuals more efficiently, improving care transitions.
However, according to a recent McKinsey study, other cost reduction opportunities are underutilized, including ensuring the appropriateness of care, engaging with patients to promote clinically appropriate site-of-care choice, and reducing the unit price of care by minimizing network leakage through in-network providers. To achieve these cost savings, it is crucial to use a care management solution that integrates care management with utilization management, supports collaboration across interdisciplinary care teams, and enables behavioral health treatment to support whole-person care.
Strategy #2: Leverage Revenue Opportunities
Improving care quality and closing care gaps not only ensures that care is clinically appropriate, coded accurately, and managed but also provides a person-centered approach that improves satisfaction. This focus can improve Medicare Stars and Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance, leading to financial incentives and bonus payments.
Allocating these dollars back into benefits can provide additional opportunities to increase coverage and improve the experience. Moreover, an attractive benefits portfolio that includes care management programs can help satisfy, retain, and attract membership. Using care management tools that automate workflows, support quality improvement and compliance, and personalize member engagement and experience can lead to higher revenue.
Strategy #3: Target the Right Sources of Value
According to McKinsey, the most successful providers can potentially save 2% to 5% from care management programs. However, if these programs are too narrowly focused or target sources of value that are achieved many years in the future, other sources of value may be missed, or the value may not be realized while the member is still enrolled in the plan.
Choosing a care management platform that brings results today is crucial. It helps strategically target high-potential cost reduction and revenue opportunities, such as helping members select in-network providers that deliver the highest-quality and most efficient care or the most clinically appropriate site of care. Additionally, it's important to ensure that care management tools enable collaboration across disciplines and report results, efficiently and effectively managing care, especially for high-risk members.
Investing in the right care management solution can help automate processes to support quality improvement while eliminating manual processing and costly errors. It can also help right-size care management to member needs at a point in time, ultimately boosting ROI while providing a better, healthier individual experience.
In conclusion, care management programs can provide significant ROI when executed correctly. By reducing medical costs, leveraging revenue opportunities, and targeting the right sources of value, risk-bearing entities and payers can improve ROI and ensure a better experience for individuals. Choosing the right care management platform is crucial in achieving these goals.