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Quality | Care Management

How Providers Can Improve Care Management Quality and Performance

May 14th, 2024 | 6 min. read

ThoroughCare

ThoroughCare

Content Team

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A performance measurement strategy evaluates whether a care management program has met its goals by using a set of metrics compared against expected outcomes.

Through the systematic collection of clinical, operational, and financial data, program leaders can assess outcomes and decide whether to improve or scale the program further.

According to the Agency for Healthcare Research and Quality (AHRQ), a successful measurement strategy allows leadership to:

  • Evaluate program success against expectations
  • Identify areas for improvement
  • Fulfill contractual or partnership terms
  • Build support to scale the program

Five steps to build a performance measurement strategy for care management

Developing a performance measurement strategy is essential. It can demonstrate the value of a care management program so that it is understood by organizational leaders, patients, and other internal and external stakeholders. 

A strategic roadmap for care management can be created in five steps. 

ThoroughCare, a care coordination platform, supports these steps to realize end-to-end performance measurement and management.

1. Define program value 

How your organization defines “value” differs from others. Yours may have specific goals that differ across all care management programs. A Chronic Care Management program, for instance, will likely have different priorities than Transitional Care Management or Behavioral Health Integration.

Defining value should follow purpose. Deciding first what outcomes are important is critical.  Leadership should create a program plan that outlines overarching objectives and priorities. This can steer the program in a specific direction, aligning resources to true goals.

2. Value stems from care management approach – population, risk, or disease

Which care management approach you take also influences the types of value pursued. Are you taking a population-based, risk-based, or disease-focused approach to care management? 

Population-based approach: This type of care management program delivers services across the entire health continuum to all patients in a panel. The care team chooses interventions based on a patient’s health status and unique needs. 

For example, according to McKinsey, payors “tend to target the same source of value for all members identified for care management rather than target the specific needs of different member archetypes.” This could include reducing preventable medical events.

However, McKinsey’s 2021 paper suggests that care management programs target multiple high-potential value areas. These programs tend to generate more than 2:1 return on investment. 

Risk-based approach: This approach focuses on risk-stratifying patient populations. It’s about implementing interventions to lower risk and cost for a particular patient cohort. 

Disease-focused approach: Care management programs hone in on the most prevalent chronic illnesses. There are target interventions toward achieving improvement in standard measures across hypertension, diabetes, and COPD, for example.  

3. Set measurement goals

Knowing the most valuable outcomes, leaders should establish specific goals that can directly or indirectly support value objectives. 

Depending on the care management approach selected – population-based, risk-based, or disease-focused – measurement goals tend to be grouped into several categories, including:

  • Clinical
  • Engagement
  • Financial
  • Operational

AHRQ offers a menu of core measures that correlate directly with upstream goals, including these examples:

  • Reducing emergency room visits by 15%
  • Increasing smoking cessation by 10%
  • Improving HbA1c control by 12%
  • Increasing the number of patients with control hypertension by 20%

It’s best to have 2-3 goals per measurement category to focus efforts. 

Clinical and engagement goals should reflect the physical and behavioral changes you want to see in your patient population. Financial and operational goals support the previous two by enabling efficiency and scale while controlling costs.

After you create clear and concise goals, it’s time to identify which measures will best demonstrate changes. This can be based on the interventions the care team selects and implements.  

4. Identify and prioritize performance measures

Many measures follow nationally recognized quality standards like those established by the US Preventive Services Task Force (USPSTF), the Ambulatory Care Quality Alliance (AQA), or medical specialty organizations and associations like the American Academy of Family Physicians.

AHRQ highlights two past Medicaid programs, showing how Pennsylvania and North Carolina prioritized their performance measures. 

Pennsylvania's program, ACCESS Plus, focused on improving the quality of care delivered to its Medicaid population through care management. It selected seven measures for each disease it covered. Pennsylvania's measures varied by type and included financial measures, clinical performance indicators, and use measures, such as:

  • Readmission rates for patients with congestive heart failure
  • Patients with asthma who self-reported the use of a controller medication
  • Patients with diabetes who received an annual dilated retinal exam

Initially, Pennsylvania included more than 40 measures but later narrowed its focus to a smaller group of measures more closely linked to meaningful interventions.

North Carolina focused on asthma and diabetes in their care management programs, choosing measures that demonstrated quality improvement and cost impact:

  • Inpatient admission rates for asthma and diabetes
  • Percentage of asthma patients classified by stage of disease severity
  • Percentage of asthma patients with a written asthma management plan
  • Diabetic flow sheet in use on the medical record
  • Blood pressure tests were conducted at every continuing care visit

These care management programs included a mixture of clinical, engagement, and operational measures.

5. Don’t overlook operational and efficiency metrics

McKinsey recommends that payor and provider organizations run their care management programs with an operational mindset. 

Clinical and engagement measures should complement operational and financial measures. This can balance clinical and engagement gains with efficiency, scale, and economic outcomes. Both sides of the ROI equation are relevant to the larger picture of care management success

A disciplined approach to care management measurement helps leaders and stakeholders correlate effort, investment, and outcomes.

Now that you’ve established your overarching goals and prioritized which measures best reflect those objectives, you will need a way to easily capture data, analyze for changes and trends, and use that output to share results and make decisions.

ThoroughCare supports every aspect of care management performance measurement through seamless data capture, robust analytics, and alerts, as well as dashboards and reports.   

ThoroughCare offers easy and accurate data capture

Analyzing performance requires various types of data, such as administrative claims, program data, clinical data, or patient surveys.

ThoroughCare seamlessly captures data during patient engagement activities. The platform enables data to be always accessible for high-level oversight or deep-dive analysis. 

The platform maximizes every manual, automated, or interoperable data point for access and analysis through prescribed workflows, guided assessments, and integrated data capture. 

ThoroughCare enables robust data analytics, dashboards, and reporting

Our platform helps program managers organize and filter patient, team, and organizational data to inform effective care strategies and streamline operations. Interactive reports, visualization tools, and real-time analysis transform information into actionable insights.

Dashboards display trends, alerts, and color-coded data, highlighting critical measures, missed targets, or concerning trends. 

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ThoroughCare’s analytics and data visualizations support insight where needed – whether that’s engaging patients, launching interventions, prioritizing goal setting, supporting behavior change or condition education.

Creating a quality improvement cycle 

High-level care management goals can only be realized and documented through initial and ongoing assessment, data collection and tracking, and periodic reviews with analysis. 

These five steps establish a foundation for your care management quality improvement cycle. 

Performance measurement and reporting provide the base for managers, leaders, and stakeholders to work toward streamlining quality care, improving health outcomes, and governing a scalable and efficient program.

ThoroughCare supports care management performance 

ThoroughCare can help providers collaborate and deliver digital care coordination and care management. Our solution can help: 

  • Streamline the creation of patient care plans 
  • Support staff workflows with guided, evidence-based assessments
  • Help motivate patients through clinical recommendations
  • Analyze patient risk factors and generate clinical recommendations
  • Identify behavioral health conditions
  • Track and log services for an audit-proof record of care

Additionally, ThoroughCare supports comprehensive integration with leading EHRs, health information exchanges, remote devices, and advance care plans. 

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