It is possible to define care management as a set of procedures and related objectives for those outcomes shared by many people in a healthcare team and as a function for a single individual known as a care manager.

To begin, what exactly is care management?

Care management is a process that begins with the patient and progresses to a team-based, patient-centered methodology that is intended to help patients and their support systems in more successfully manage medical problems. It also includes the care coordination tasks necessary to manage a chronic disease. According to recent research, care management has been demonstrated to be an effective method of assisting patients in improving clinical values, reducing needless care, and lowering healthcare expenditures. But if it is not appropriately done, care management may be costly and ineffective, with little or no influence on results.

Here are some basics that can help:

Research the Current Coverage

The funding arrangements for primary care may have direct and indirect consequences on the delivery of services. Reimbursement systems may provide incentives to fulfill policy goals such as expanding access to treatment, enhancing the quality of care, managing costs, and recruiting doctors to underprivileged parts of the country. Consequently, structured reimbursement may either alleviate or exacerbate existing healthcare imbalances.  Payment for services via a fee-for-service model (in which the provider is compensated for each item of service rendered) may expand access to treatments. Still, it may also raise the risk of overtreatment. 

Capitation reimbursement (in which a provider gets a monthly lump sum payment per listed patient regardless of the services given) may be used to promote cost-effective treatments and preventative services.  In practice, however, physicians may be tempted to undertreat patients or choose to list healthier people, jeopardizing the availability of treatment for vulnerable groups. Compensation via capitation may be modified for age, socioeconomic status, and illness diagnosis to offset some consequences. 

Pay-for-performance payment (in which providers are reimbursed based on process and outcome indicators of clinical significance) improves the overall quality of treatment and has been used to supplement existing compensation strategies in several countries. Nonetheless, there have been concerns that compensation for performance might exacerbate injustice if healthcare professionals choose patients more likely to have good results than those less likely to have favorable outcomes.

Establish Your Goals and Set Your Parameters

Individuals from every business and profession are eager for new ideas that can assist them in solving issues, providing better service to their clients, earning more money, or just getting home in time to cook a meal. Family doctors are not exempt from this rule. Unfortunately, bold ideas may be challenging, particularly in a fragile economy when Medicare payments have been flat while expenses have continued to rise. When sailing in severe seas, it’s tough to concentrate on anything other than remaining afloat and not being swept away.

It is especially at this point that a significant concept is required.

  • Recognize the importance of a half-day of labor
  • Allow coworkers to share a job.
  • Ask yourself, “What does my reception area say about me?”
  • Your house should serve as a medical facility.
  • Try the 5 Whys formula
  • Incorporate a new procedure into your practice
  • Move the community in your favor to support your work.
  • If you can’t do it all, ask for professional assistance.

Encourage Patient Accountability by Implementing Enhanced Financial Incentives  

Because money drives our behavior is so ingrained in our society we seldom take a moment to consider it. Two-for-one bargains influence consumer and work-life decisions on anything from movie tickets to apparel, cheap plane tickets, or the promise of substantial yearly bonuses.

So the question arises, why not healthy behavior?

The CMS Premier Inc. Hospital Quality Incentive Demonstration is a notable example. As a result of this protest, which comprises more than 100 hospitals. A larger payment (bonuses) is given to the best-performing hospitals, whereas the worst-performing hospitals may be subject to withholdings (penalties). It’s based on how well they treat patients with heart attacks, heart failure, hip and knee replacements, coronary artery bypass graft (CABG), and pneumonia, all proven effective.

More than half of the existing efforts that connect performance to payment employ bonuses to reward providers with extra payments when they meet specified performance objectives, making it the most frequent incentive model in the US.  The main distinction between performance-based fee schedules and bonuses is that the payment is continuous rather than one-time or periodic.

Enhance the overall quality of healthcare            

On both a macro and micro level, improving healthcare quality may need broad, systemic change across the whole healthcare system and something that individual doctors can do for their patients to help them achieve better health. Increased openness in the healthcare business and a need for practitioners to utilize patient-centered electronic health records (EHRs) that are readily available to all care providers and the patients themselves have the potential to enhance healthcare quality significantly. In the same way, doctors may enhance the quality of healthcare they provide to their patients by following procedures to keep them safe from infection, following up with them more often, or linking them to better resource opportunities.

Here are some immediate changes primary care professionals may take to enhance the quality of healthcare they give to their patients:

  • Patient Outcomes are being collected and analyzed
  • Establish goals and commit to ongoing evaluation
  • Improve the availability of healthcare services
  • Emphasis should be placed on patient engagement
  • Identify opportunities to connect and collaborate with other organizations

Ensure instant Feedback on Process Improvements in healthcare

Because healthcare is so tailored to the individual patient, implementing quality improvement techniques is frequently thought to be difficult. Despite this, an increasing number of hospitals are proving this hypothesis incorrect. Hospitalization systems and procedures may exist side by side with patient-centered care—the organization’s “back-end” operations can influence the well-being of an individual patient to the point where quality improvement measures can be adopted.

  • Encourage people to participate in hands-on renovation initiatives
  • Obtain consensus on what “quality” entails
  • Measures should be geared toward progress rather than accountability
  • Make use of a quality improvement framework that has been proven
  • Recognize the difference between intentional and accidental data fluctuation


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