What We Talk About When We Talk About Care Management

Drs. Marcotte and Liao articulate a framework for categorizing care management as disease management, utilization management, and/or health care navigation interventions -- a tool that can help providers and payers invest in, implement, and reap benefits from care management programs.

Why is such a framework needed? As the authors note:

"Hospitals and physician groups increasingly view care management as a key area for investment and as a strategy for succeeding in a value-based environment, and there have been isolated reports of success within value-based payment models.

However, despite widespread enthusiasm, complex care management and coordination activities are not associated with differences in quality, utilization, or cost outcomes in prominent value-based payment models such as the Medicare Shared Savings Program (MSSP).

One potential driver is the variability in how care management programs are defined and implemented. For instance, a survey of individuals leading care management programs demonstrated such a wide range of roles, program characteristics, patient selection methods, and measurement strategies that researchers faced challenges when attempting to classify programs."

This article reflects a larger body of work lead by Drs. Marcotte and Liao to advance implementation strategy related to value-based payment and delivery models. Learn more about that portfolio here.