Periodic performance reviews are crucial to ensuring any care management program meets its objectives. However, creating a process and determining which data to focus on can be challenging for a new or expanding program.
A care management performance analysis process can be customized for a provider’s goals. Armed with this information, care managers can identify areas of success, quality improvement opportunities and make data-driven strategic decisions.
ThoroughCare, a leader in care management best practices, supports clinical workflow development with expert advice and a software platform that simplifies compliance. We help providers design performance review processes and use comprehensive data to improve care delivery.
In this article, we’ll cover a few key points to consider in a care management review process. ThoroughCare is recognized by the National Committee for Quality Assurance (NCQA).
Our platform is NCQA Prevalidated for Population Health Management in Health Plan Accreditation.
Figure 1 lays out a five-step process for care management performance monitoring.
These five steps include:
Figure 1: Five-step care management performance metrics process.
Establishing a performance review schedule and having a repeatable process are essential.
Some key performance indicators (KPIs) should be reviewed monthly, while others may be better suited for quarterly or semi-annual reviews.
As you create a desired metrics list—or review data analysis, dashboards, and reports available in ThoroughCare—make note of which should be reviewed at what interval.
In addition to clinical workflow development and training, ThoroughCare’s Clinical Advisory Services can also provide care management performance reviews. Experts are equipped and experienced in assessing CMS compliance, operational output, billing and reimbursement practices, as well as clinical quality and care standards.
Consider the following four foundational performance areas as part of your review process, including:
Depending on your care management goals, you may want to consider other metrics, such as population health and KPIs related to specific care management programs. These could include Chronic Care Management, Remote Patient Monitoring, Transitional Care Management, or Annual Wellness Visits.
In order to prioritize performance metrics, review the program goals set when the care management program was established.
According to the Agency for Healthcare Research and Quality (AHRQ), it’s vital to understand the motivations for creating or expanding a program and select metrics that indicate progress on goals.
They highlight several reasons providers launch care management programs, including:
Quality improvement: Care management aims to improve healthcare quality, care coordination, and service delivery, particularly for beneficiaries with chronic conditions.
Cost Savings: In addition to care quality and clinical outcomes, some programs aim to reduce care costs, particularly when the program is part of a value-based contract.
Supplemental revenue: Most programs have multiple goals. Medicare care management programs can add fee-for-service revenue to enhance patient services.
After clearly identifying the performance metrics you want to assess and how often, steps 2 and 3 focus on data collection and analysis.
Various KPIs can be tracked via dashboards and reports, such as within ThoroughCare, across four performance review areas. Here is a sampling of data points available within each area:
Using this data, providers can assess the overall value of care management services and calculate return on investment. A previous blog provides a more in-depth review of KPIs covered through ThoroughCare.
Other metrics complement the four assessment areas mentioned—clinical, operations, engagement, and financial. Those include data related to population health and specific care management programs.
ThoroughCare provides a variety of population- and program-based dashboards and reports.
Here are a few areas that may be useful as part of a performance review process.
Reviewing population health metrics complements individual patient and program trends, giving insight across various patient cohorts, including:
Data can provide insights and visualizations of performance trends and patterns or offer comparisons against previous periods. Providers can create overview documentation and presentations that demonstrate progress and benchmark to industry standards.
ARHQ suggests that organizational policies and interventions work together to impact provider and patient behavior. If the interventions are effective, they should lead to high-quality clinical care and effective patient self-care. These will yield desirable health and economic outcomes.
They recommend looking at the program process, intervention impact, and health outcomes to answer three questions from the collected data:
Step 4 focuses on discussing the trends and patterns in light of the questions posed and program goals. Step 5 finalizes the process by creating an action plan for improving results for the next reporting period.
After celebrating successes, identify gaps in performance.
The final step establishes strategies for improvement.
This is the time to prioritize the next steps, assign action items and responsibilities to team members, and set deadlines for follow-up.
ThoroughCare’s reporting and analytics capabilities provide KPIs needed for robust oversight, compliance, and management of care programs.
The easy-to-use reports and dashboards also support quality and performance improvement, ensuring a program meets its care delivery and patient goals.
Consistent and regular review of care management program performance is essential to achieving clinical, patient, and financial goals. Using our care management performance review process, initiate the following steps: