We sat down with David Lischner, Valant’s CEO, to understand why he is so excited about the future of care management and the possibilities open to behavioral health and human services organizations. A few coffees and questions later, this is what he had to say:
So what is “care management”? When I say care management, what I mean is a form of population health management. Care management is the centralized overview and organization of a patient population’s distributed care to achieve specified health outcome goals.
How is that different from models of care coordination or case management? They’re interconnected: Care coordination refers to the synthesis of information from disparate data sources with the purpose of improving collaboration between health providers that comprise a treatment team. Case management refers to the activity of an individual manager related to care management and care coordination.
What makes care management so important to behavioral health and human services?We think that the behavioral health specialty has its hands on one of the biggest levers in healthcare! With its expansion, Medicaid has 69 million enrollees and $465 billion in total spend. 50% of Medicaid spending goes to the neediest 6% of Medicaid enrollees using long term services and supports (LTSS). These are the types of hard-to-reach health consumers that care providers in the health and human services (HHS) industry are especially good at reaching, engaging with, and influencing their health behaviors.
Why is innovation so important to care management initiatives? HHS providers are engaging in experiments across the country at a rapid pace and in many cases, showing the payers and other industry stakeholders how it is done.
Is there anything holding back care management as it stands now? I’ve heard over and over how agencies and service providers would take on more opportunity, including with commercial payer populations, if they were enabled with the right technology. This is a great chance for behavioral healthcare organizations to lead. They just need their technology industry partners to join them and move in the same direction at the same pace.
How should we expect technology to improve care management? Care management has a million definitions but some common characteristics:
- Contract with payer
- Coordination of care
- Exchange of data
- Analysis of that data
- Context- or condition-specific care management workflows
- Defined health outcomes
- The need for teamwork
Current EHR data models do not support these use cases. Even great new care management technology is only as good as the data feeds from EHRs and other sources. “Real-time data” is usually a myth or requires enormous investments by service providers. A new extensible data model could integrate the EHR, analytics, care management workflows and health exchange functionality on one unified platform.
What needs to happen next? I believe that the HHS technology industry needs to step up and create that kind of new platform. The good news is that the technology exists now to do this. We just have to have find the will to let go of old business models and make the leap. Looking for more? Click the button below to download our whitepaper and learn more about the disruptive convenience that is coming to the health and human services industry.