Embedded vs Remove Care Management Delivery Models and Their Impact on Achieving the Quadruple Aim


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Presentation: 54:52


As the health care industry transitions from fee for service to value-based reimbursement, the role of the professional care manager in the delivery of high-quality, low cost care is evolving rapidly (Luo, et al., 2016). Identified as a key strategy to success in value-based payment models, care management programs vary widely in their scope, design and delivery (Kodner, 2015). Health plans that once provided remote care management services as a means to impact quality, cost and utilization are beginning to invest their resources in care management delivery models that are embedded in the Patient Centered Medical Home (PCMH) (Luo, et al., 2016). This represents a significant shift in strategy that positions the care manager alongside the Primary Care Provider (PCP) as a key member of the care team. Through a comparison of published studies and case presentations, this paper aims to understand whether or not the delivery setting for care management is relevant in meeting the goals of the quadruple aim: improved health outcomes, reduced cost of care, and enhanced patient and provider experience. Though there is limited research available that examines the question in totality, evidence exists to support that embedded care management models might be more effective than remote interventions at improving the health outcomes and health care experiences of complex patient populations and reducing provider burnout. Less conclusive evidence was available to support care management as a consistent factor in the reduction of the cost of care per capita. In an effort to standardize and replicate an effective care management program, a set of high-level evidence based best practice recommendations was assembled and organized.



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