As health plan sponsors and payers seek more ways to meet the needs of their members, they are realizing the importance of personalized data. They are also realizing that case managers/care managers can and are playing a key role in meeting this goal, in addition to population health management objectives.
Meeting Health Data Challenges
Case managers have always played a pivotal role in identifying health behavior patterns and red flags in their patients, recording those findings, and then sharing their findings with other members of the patient’s team. Now, their role in health data strategies has increased. This is especially true for plan sponsors’ and payers’ care management teams. In addition to the data plan sponsors and payers have gathered and are managing (i.e., claims, member demographics, employment history, etc.), care managers are able to gather member health data, consistently, supporting more effective personal care and improved health outcomes, while also contributing to today’s emphasis on whole person care.
Other Benefits of Case Managers Enhanced Data Role
By taking this approach in care management, case managers are also able to meet other needs for plan sponsors and payers. From a financial standpoint, case managers’ data capture and use strategies help minimize unnecessary expenses and contain overall health costs. They also recognize and focus on social determinants of health as part of their role (e.g., family and support systems, home environment, access to community resources, emotional needs, etc.). These again play into the whole person care objective and can significantly impact a patient’s compliance with their treatment plans and well-being. The World Health Organization reported that social determinants of health account for 30-55% of health outcomes compared with clinical care used alone. Case managers, therefore, are assisting plan sponsors/payers in delivering an improved care experience for their members.
Data Generation and Application
Through their ongoing communications with their patients, and data capture, the information can be applied to support more targeted patient/member care while increasing engagement with the patient and their family members. The open dialogue fosters better communications, which in turn fosters more personalized and cost-effective care. The bottom line is that case managers are leveraging data to support both their patients’ better outcomes, as well as the goals of plan sponsors and payers.