Care Management Blog

Managing hyperlipidemia (high cholesterol) can be overwhelming—but it doesn’t have to be. In this video, we break down how care management plays a vital role in helping patients lower their cholesterol levels, reduce cardiovascular risks, and lead healthier lives.

“Workflow” often means “how you get needed work done.” But there is more science, discipline, and skill behind optimizing care management operational workflows.

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.

The Centers for Medicare & Medicaid Services (CMS) created the Shared Savings Program (SSP) to encourage physician groups, hospitals, and other healthcare providers to support more coordinated, high-quality, and cost-effective care.

Launching or expanding a care management program comes with certain challenges.

The Centers for Medicare & Medicaid Services (CMS) allows billing practitioners to collaborate with third-party care management service companies. This arrangement can provide external clinical staff and non-clinical staff to perform certain care tasks.

Providers and third-party service companies want to deliver accessible and convenient care that has an impact.

Over a decade, the Centers for Medicare & Medicaid Services (CMS) tested various value-based innovation models focused on improving primary care. Models like CPC, CPC+, and Primary Care First demonstrated that “comprehensive primary care can lead to reductions in emergency department and hospital visits while better meeting patient needs.”

Many physicians and clinicians pride themselves on the relationships they develop with their patients. By creating a patient-centered care plan, providers can enhance engagement, deliver timely interventions, align on outcome goals, and improve care team coordination.

This year brings significant opportunities and changes to care management that invite providers, health plans, and care management service organizations to transform. Central to these changes is the launch of the Advanced Primary Care Management program.