Care management transformation in a time of change

Today’s health care landscape presents new challenges for health plans and other stakeholders that require a change in thinking around traditional care management models. Current models are fragmented, and do not address preventive and chronic care needs of every patient. Three critical shifts are driving a transformation to population health management:

  1.  A changing payment model that incorporates outcomes-based risk-sharing agreements is putting greater emphasis on quality ratings, like Stars and HEDIS. There is also an ongoing need to drive more cost-effective care for the entire managed population.
  2. Membership continues to evolve as a result of the growth in exchanges and government-sponsored plans. These members have expectations of seamless, integrated and personalized experiences.
  3. Care management models need to better identify population health and care delivery system variations, and leverage community resources, providers and staff to create a consumer-center care model.

One of the greatest challenges health plans face is to stratify member populations to pinpoint value and prioritize interventions to drive consumer activation and improved outcomes. This requires robust data and analytics based on integrated data from multiple sources — medical and behavioral claims, pharmacy, labs and other health records that create a whole-person view.

These analytics can then be used to feed dashboards and decision-making tools across the continuum of care, which are easily accessible by all team members and capable of supporting updates in real time. As a result, health plans can deploy care plans effectively and consistently to reach high-cost and emerging risk members.

For care management to better meet the needs of all members, it must address the whole person in a manner that is data-driven, seamless and member friendly.

  • Member engagement should be personalized and local, employing a multidisciplinary team.
  • Interventions must be focused on addressing the needs of the whole person, across the care continuum.
  • Integrated data from a variety of health records

Bernie Elliott, MD, chief clinical officer and senior vice president of clinical alignment at Optum, shares his perspective on the drivers of population health management in this short video.


About the Author:

Bernie Elliott

Bernie Elliott, MD
Chief Clinical Officer and SVP Clinical Alignment
Dr. Bernie Elliott’s role involves clinical oversight of the delivery of Optum’s population health management intervention programs. Prior to his role with Optum, Dr. Elliott’s spent over a decade as an owner and partner of a large-group multispecialty practice. He has also served as John Deere Health’s Vice President of Medical Management, where he worked in partnership with the other physician leaders to oversee the full spectrum of health services offered.

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