PP108 – Care Standardization driven by Case Management to achieve clinical Outcomes
Case Management can make significant impact on clinical outcomes by standardizing care in Chronic Conditions in Disease Management Programs. Using Evidence-Based Standards in a systematic way ensures high-quality that is consistent, effective, and safe across the Populations. By identifying 5-10 Evidence-Based Standards of Practice for COPD, Diabetes, and Heart Failure, Carelink CareNow has made substantial progress in reducing the cost of Chronic Disease across the Populations we serve. Using our Health Information Exchange, we identified 400 of our Diabetic Commercial at-risk members with HGA1C levels > 9. In a years’ time 37% of the identified members were below 9, with a cost avoidance estimated at $1.1 million. Additionally, we saw a 12.6% reduction in 30-day readmissions in a 90-day period in our COPD Population following engagement with Carelink. Standardized care is a combination of Evidence-Based Best Practice, patient staging based on Disease Process, program leveling, and a checklist of Short-Term and Long-Term Goals. At Carelink we use this methodology in conjunction with specific tools and real time alerts identifying patients at risk for disease exacerbation and real time utilization feeds from our Health Information Exchange. Clinical Outcomes and Quality Measures are continuously evaluated.