6003 – Utilizing Tech Tools to Identify and Prioritize Care Management Efforts
Leaders of care management are well-positioned to guide their organizations to succeed in value-based care initiatives. However, as these initiatives grow in size, care management is being asked to help more patients with the existing staff, placing an emphasis on identifying and prioritizing patients most in need to have the greatest impact. Yet, care managers often do not have timely patient health data to help them identify and proactively reach out to worsening patients to prevent unnecessary utilization. At Esse Health, we implemented a text message-based remote monitoring tool enabling our high and rising-risk patients to report their symptoms and biometrics and interact with us when they have questions or needs. I will share how patients increased chronic condition self-management and reported worsening symptoms. This enabled our care managers to proactively intervene with patients resulting in a 30% reduction in ED visits and a 19% reduction in medical claim costs in a Medicare Advantage population. Importantly, patients reported high satisfaction and that they felt connected and supported. When implemented properly, remote monitoring tools can scale the impact of care management teams to increase overall performance within value-based contracts.