Historically, health plans were forced to choose between care management systems that offered best-of-breed functionality but required heavy involvement from IT and those that were missing key capabilities but could work seamlessly within the context of the organization’s ecosystem of other systems with limited IT effort.
However, times have changed. Modern care management systems, like GuidingCare® from HealthEdge®, enable health plans to get the best of both worlds – best-of-breed functionality in a highly interoperable and composable platform.
It’s important to break down the definition of a modern care management system to better understand the bottom-line benefits health plans should expect. There are three must-haves for modern care management solutions.
- The system must be able to access and share a variety of data across the IT ecosystem. Important clinical data can come from virtually anywhere these days – from a primary care provider’s EHR system to a member’s Apple watch. In addition, non-traditional data such as social determinants of health (SDOH) data are becoming increasingly available and can unlock valuable insights into the member’s ability to follow their care plan. Claims data can also be mined to proactively identify patients who may be at risk of disease or costly complications.Much of this data is unstructured and difficult for outdated care management systems to assemble and turn into actionable information. However, all of this data is critical to care managers who are charged with understanding their member’s health risks and supporting the execution of care plans that help to minimize those risks.
- The system must be able to accommodate real-time data exchange. It’s one thing to be able to share data across systems and care settings, but it’s another thing to be able to share data in real-time. Legacy care management systems were not designed to accommodate modern data exchange standards and are putting organizations at risk of missing critical opportunities to impact member health in real-time and expand their member services.Modern care management systems, such as HealthEdge’s GuidingCare, have embraced API-based integrations that allow them to share data in real-time through RESTful APIs and JSON payloads. This not only empowers care managers to help members avoid adverse events, such as hospital readmissions and falls, but it also gives them instant access to important member benefits information so they can make more informed decisions at the right time.In addition, more timely data is typically more accurate data. By ensuring the most current and accurate data is readily available to care managers, providers, and members, organizations can build long-lasting, trusting relationships.
- The system must be open and capable of working seamlessly with other software systems. Care management systems sit at the core of every payer’s ability to do what they were originally created to do – facilitate care for their members. But in today’s complex healthcare environment, no single system can do it all. Many organizations have up to 25 different systems in their ecosystem that must work together to optimize member health and wellness.When these solutions cannot work together to take advantage of the strengths of each system, costly manual processes and custom workarounds are required. This drags down an organization’s ability to respond to member demands and market changes. Therefore, the IT overhead becomes an overwhelming burden that further erodes margins and puts the member’s experiences at risk.
To learn more about what a modern care management system can do for your organization, check out our new white paper, Transforming Healthcare: The Role of Open and Flexible Care Management Systems.