Primary care is the foundation of US healthcare. It’s reported that primary care is the “only” area in which providing more services—such as childhood vaccines and regular blood pressure screenings—is linked to better population health and more equitable outcomes.

According to research published in the journal Primary Health Care Research & Development, there is strong evidence that care management benefits patients and providers by:

The need for tighter payor-provider partnerships has never been greater.

Physician practices, payors, and health system leaders rely on key performance indicators (KPIs) to achieve their clinical, financial, and operational goals.

Health behavior change is challenging for most individuals and can be particularly difficult for patients living with chronic health conditions or physical, mental, or social risk barriers. Care management programs and clinical teams can provide personalized and powerful support to facilitate the changes that patients seek.

Approaching Advance Care Planning (ACP) discussions with patients requires doctors to cultivate an environment of trust, empathy, and open communication. Doctors should create a safe space where patients feel comfortable expressing their values, fears, and goals for medical treatment. By approaching ACP discussions with compassion, respect, and sensitivity, doctors can empower patients to make informed decisions about their healthcare journey.

Physicians and other qualified providers working within nursing and assisted living facilities can deliver covered care management services, according to The Centers for Medicare & Medicaid Services (CMS). So long as they meet all billing requirements, and the claim is submitted using a specific NPI number. These services include:

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