Reframing Value-Based Care Management

Abstract

ImportanceCare management programs are increasingly being utilized by health systems as a new foundational strategy to advance value-based care. These programs offer the promise of improving patient outcomes while decreasing health care utilization and costs. However, as these programs proliferate in number and specialization, the field of care management is increasingly at risk of fragmentation, inefficiency, and failure to meet the core needs of the patient.ObservationsThis review of the current state of care management identifies several key challenges for the field, including an unclear value proposition, a focus on system- vs patient-centered outcomes, increased specialization by private and public entrants that produces care fragmentation, and lack of coordination among health and social service entities. A framework is proposed for reorienting care management to truly address the needs of patients through acknowledging the dynamic nature of patient care needs, providing a continuum of need-targeted programming, coordinating care among all involved entities and staff, and performing regular evaluations of outcomes that include patient-centered and health equity measures. Guidance on how this framework can be implemented within a health system and an outline of recommendations is provided for how policymakers may incentivize the development of high value and more equitable care management programs.Conclusions and RelevanceWith increased focus on care management as a cornerstone of value-based care, value-based health leaders and policymakers can improve the effectiveness and value of care management programs, reduce patient financial burden for care management services, and promote stakeholder coordination.

Thoughtful Investing in Social Care Management

“…The enthusiasm for value-based care has been accompanied by little guidance as to how, who, or when health care providers should be screening for health-related social needs. This ambiguity has contributed to an ecosystem in which both health care organizations and CBOs have, perhaps unintentionally, landed on the same solution to these new screening and referral workflow needs—care management (Wang et al, 2023). Care management may be appropriate for this newfound attention to social needs in health care settings, but there is a risk of overinvestment in care management, with the potential to make an already complex system more complex, and duplicating care management services at the cost of providing health-enhancing social services.…”