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3 ways to build an effective complex care management program


To manage high-risk patients successfully--keeping costs low while improving their overall health--insurers often look to complex care management (CCM) programs.

Effective programs identify members' needs using qualitative and quantitative methods and focus on building trusting relationships with patients and primary care providers, according to a new issue brief from the Commonwealth Fund.

So what makes a successful CCM program? Here are three suggestions from the brief: 

1. Determine operational control

There are multiple approaches to take when establishing a CCM. The payer-operated model allows for more flexibility within the program and also has more access to financial resources. The delivery system-operated model uses data integration and has greater connectivity with providers across the delivery system.

2. Cater to the population

The Commonwealth Fund found that an effective CCM pays attention to the population it serves. So make sure to establish the program in a practical location.

When forming a team for your CCM, make sure to assign key roles, such as care manager, community resource specialist, behavioral health provider and other clinician specialists. Teamwork is the name of the game, so encourage regular face-to-face meetings and constant communication.

3. Share information 

An effective program--one that provides a high-level of care while also maintaining reasonable costs--shares timely information about patients, such as an emergency department visit, which could help avoid costly readmissions.

The CCM teams should develop protocols for end-of-life care, so everyone is familiar with the process. A few programs have palliative care for their patients, such as Cambia Health, whose program aims to empower consumers' role in their healthcare by creating a person-focused program that emphasizes patients and their families.

For more:
- here's the Commonwealth Fund issue brief (.pdf)

Related Articles:
Cambia Health CEO Mark Ganz on the cutting edge of end-of-life care
Palliative care coverage: Connecting the dots
Aenta pilots program to cut med-related readmissions
BCBSNC teams with SAS to create personalized plans