The Benefits of Care Management

Improved Communication and Information Sharing

Care management facilitates this through care plans, health records, and provider coordination. Regular case conferences keep all team members aligned on patient goals and care plans.

Patient-Centered Focus

The team considers the patient’s needs, goals, and values, not just a specific condition. This patient-centric view leads to better care. Developing integrated care plans outlining patient preferences and desired health goals facilitates this patient-focused approach across the care team.

Enhanced Care Coordination and Access

Care management allows for continuous, coordinated care across different healthcare settings. This reduces duplication of services, medical errors, and gaps in treatment. Patients benefit from smooth transitions between hospitals, rehab facilities, home health care services, and outpatient providers.

Additionally, the diverse expertise within the care team provides patients with access to behavioral health services, pharmacy support, rehab, home care, and community resources. This whole-person approach gives patients the comprehensive services they need at the right time.

Better Health Outcomes

Care coordination leads to better health outcomes for patients by reducing gaps in care and ensuring appropriate treatment. Studies show collaborative care improves outcomes for various chronic conditions. Patients get preventive services, follow treatment plans, and have support managing chronic illnesses.

Care Management at Its Best

There are many opportunities to improve coordination, including:

• Shared care plans: Providers update a central integrated care plan across settings. This covers medical information, medications, tests, specialist referrals, etc.
• Integrated healthcare records: All providers access the same comprehensive patient record. This helps avoid duplicate tests and situations when patients take medications that pose health risks when taken at the same time.
• Multidisciplinary care conferences: The care team meets regularly to align on patient needs, goals, and next steps.
• Embedded providers: Integrating mental health professionals into primary care clinics gives patients easy access to behavioral health services.
• Medication management: Pharmacists review and reconcile medications across transitions and liaise with providers.
• Palliative care: Early integration of palliative care for seriously ill patients provides an extra layer of support.

Implementing Care Management

Steps include:

• Assessing gaps in care coordination by gathering data on duplication, fragmentation, and lack of communication.
• Engaging care providers across inpatient, outpatient, rehab, skilled nursing, and community settings through regular meetings.
• Implementing tools like shared electronic health records, patient portals, care management software, medication management systems, patient self-management, and information exchange.
• Developing protocols and incentives that facilitate team-based care rather than siloed care.
• Collaborating with dedicated care coordinators to guide patients across settings.

The transition takes commitment but pays off through improved quality, reduced costs, and better patient and provider experiences.

We are committed to care management and collaborative care at Legacy Care because we know it leads to better patient outcomes. You deserve coordinated care that revolves around you. Contact us today to get started.