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Chronic care management will separate leaders from the pack in 2019 (and beyond)


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As 2019 unfolds, we’re taking a look at the trends that will have the biggest impact on health care. Increasingly, one trend stands apart: chronic care management. Not only is it a significant focus in its own right, but it’s become a major ingredient theme for many other healthcare trends, including healthcare consumerism, the shift toward patient-led care and the development of innovative care delivery models. Overall, chronic care management will stand out as a top priority for providers over the next three to five years.

Here’s why.

The Crux of Clinical Decisions: Patients
“Not only is chronic care management increasingly prevalent and expensive, there’s a need to use more robust data-driven insights to inform clinical decisions, improve outcomes and keep patients at the center of care,” said Dr. Jay LaBine, chief medical officer at naviHealth. “With this in mind, as providers transition to value-based care, serving the chronic care population in new and innovative ways will be critical to success.”

naviHealth Chief Medical Officer Dr. Jay LaBine
naviHealth Chief Medical Officer Dr. Jay LaBine

According to Rand, patients with chronic conditions account for over 90% of the nation’s healthcare expenditures — leaving chronic care management as the most obvious means to streamline care delivery and reduce costs while looking to improve the quality of care.

Dr. LaBine believes there are a number of trends that may help providers in their focus on chronic care management. One example is the recent shift to move risk from payers to providers with programs such as BPCI Advanced and the ACO overhaul. These programs encourage providers to have more proactive approaches to care coordination.

As a result, there is strong incentive for providers to align to improve quality of care and reduce costs among chronic care populations while looking for innovative ways to deliver patient-focused care. Many such strategies are already emerging, including:

  1. Home-based primary care and moving extended care to the home.
  2. The expansion of community-based services in alignment with health systems.
  3. Moving care directly to the community, such as with companies like DispatchHealth disrupting traditional urgent care models.
  4. Innovative delivery models across providers, such as with acute and post-acute providers aligning in BPCI Advanced to provide bundled episodes of care.

Such strategies not only help improve care for chronic populations, they also align neatly with other care trends. For instance, with the increasing consumerism of health care, providers are being driven to provide patients with consumable, accessible healthcare data — which forces healthcare organizations to rethink traditional delivery models.

Social determinants of health have also come into focus for healthcare organizations. Providers and clinicians are beginning to understand the significant impact of things such as a patient’s lifestyle or financial situation, when determining their health plan. Moving beyond traditional, strictly medical determinations, providers are looking to provide unique, targeted interventions for both high-risk population subsets and individual patients, often through community-based care initiatives.

Concurrently, providers will leverage strategies like genomics and precision health to help narrow their targeting and provide greater value for care delivered.

“For health care in 2019, the questions we need to ask ourselves are clear: can we offer care in a more thoughtful and consumer-friendly way? Can we personalize patients’ care? Can we develop innovative delivery models and community-based services to better serve chronic care populations? And can we align providers in these efforts to better serve patients?” said Dr. LaBine.

A Plan for Chronic Care Management
In searching for a template for chronic care management, health systems are fortunately not without precedent. Medicare Advantage (MA), in particular, has demonstrated successfully how to administer innovative, coordinated care management, at reasonable cost. Not only is MA enrollment increasing in 2019 (with 600 new plans and falling premiums), but nearly 1.5 million patients will receive access to a variety of supplemental and community health benefits, including in-home support services, caregiver support services. adult day care services and additional benefits for those with chronic disease such as diabetes and congestive heart failure.

“Medicare Advantage will, in all likelihood, move the needle on chronic care management,” said Dr. LaBine. “In terms of accounting for social determinants of health, providing robust supplemental and community care benefits while helping providers improve outcomes at full risk — in many ways — it’s become a template for success.”

Regardless of how healthcare evolves chronic care management will no doubt emerge at the forefront of providers’ and healthcare organizational plans. With the need to better serve chronic care populations, streamline care delivery and lower costs, delivering innovative care solutions while taking a holistic, personalized view of the patient will surely be a point of emphasis throughout the industry.