PP316 – Can Automated, Evidence-Based Text Messages Help Case Managers Engage and Identify Rising-Risk Patients?
Care Managers are increasingly responsible for the success of value-based
care and population health initiatives. To support care management’s efforts to reduce unnecessary ED visits and utilization, evidence-based remote care monitoring tools are helping engage, monitor, and identify rising-risk patients in the community. To have
the largest impact, care managers should consider tools that maintain long term patient engagement, generate actionable data and enable remote monitoring of co-morbidities. In two studies, we evaluated the impact of remote care monitoring on reducing risk of
first-time heart attack or stroke, and reducing A1c among patients with uncontrolled diabetes.
1. Learner will list 3 ways care managers can monitor and identify rising-risk
patients in population health initiatives
2. Learner will identify key
criteria that influence long-term patient engagement
3. Learner will describe the
importance of addressing diabetes and cardiovascular health, two common comorbidities.