Traci Haynes, MSN, RN, BA, CEN, CCCTM
The need for care management continues to grow exponentially in the United States. The ever-increasing number of chronic conditions in both adults and children has placed greater demand on healthcare resources and services. US healthcare spending reached an all-time high of 3.81 trillion dollars in 2019, with a predicted growth to 4.01 trillion dollars this year.
In a report from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary, healthcare spending is expected to grow by 5.4 percent from 2019 to 2028. This prediction will result in healthcare spending at 6.19 trillion dollars and will account for 19.7 percent of the gross domestic product (GDP), up from 17.7 percent in 2018.
The Center for Disease Control and Prevention’s (CDC) National Center for Chronic Disease Prevention and Health Promotion indicates that six in ten adults in the US have a chronic disease and four in ten adults have two or more. The CDC also estimates that about 25 percent of children in the US, ages two to eight, have a chronic health condition. They report that a concise list of risk behaviors causes many chronic diseases. These include tobacco use and exposure to secondhand smoke; poor nutrition, including diets low in fruits and vegetables and high in sodium and saturated fats; lack of physical activity; and excessive alcohol use.
Many of the complications of the most common and costly chronic conditions such as heart disease, stroke, diabetes, COPD, obesity, and asthma could be prevented or better controlled. Also, many individuals who struggle with multiple conditions often have combined social complexities. Even the most clinically astute patients find it difficult to navigate complex and fragmented healthcare systems, especially when the responsibility falls to the individual alone without adequate support or partnering. This difficulty in navigating healthcare systems often results in inefficiencies, increased costs, and poor outcomes.
The Agency for Healthcare Research and Quality (AHRQ) states that “Care management is a promising team-based, patient-centered approach designed to assist patients and their support systems in managing medical conditions more effectively. It also encompasses those care coordination activities needed to help manage chronic illness.
In 2012, The American Nurses Association (ANA) stated that “Patient-centered care coordination is a core professional standard and competency for all nurses, and should be the foundation for all care coordination programs.” They also said, “Nurses need to position themselves within the interprofessional team to perform this core nursing process and contribute to better patient outcomes.”
Doing this involves systematic, organized teamwork, including the patient and family, and requires communication among all participants.
Currently, care coordination is one of the National Quality Strategies of the National Quality Agenda. A coordinated effort involving an interprofessional team with the patient and their family can help achieve the Institute of Healthcare Improvement’s Triple Aim goals of better care, better health, and reduced costs.
As part of their triple aim interventions, the AHRQ supports identifying populations with modifiable risks, aligning care management services to the needs of the population, and identifying, preparing, and integrating appropriate personnel to deliver the needed services.
Contact Center Support
The contact center can play a vital role in managing and improving the patient’s condition. By routinely checking on the patient at predetermined intervals and monitoring the individual’s plan of care, the contact center can communicate with the interprofessional team providing a picture of the patient’s current and recent status at that particular point in time.
Using telecommunications can provide invaluable connectivity to monitor patients and provide a meaningful 24/7 service for clinical assessment capability and episodic care and interventions, should the need arise. And now more than ever during these unpredictable times, individuals both with and without chronic conditions, are avoiding or delaying preventative and needed care.
Nurses provide invaluable expertise in coaching, educating, and improving an individual’s self-management skills, thereby increasing the quality of care, resulting in better outcomes. They are also able to provide an assessment of symptoms and recommend interventions, often decreasing exacerbations.
The ANA, the American Academy of Nursing (AAN), the American Academy of Ambulatory Care Nursing (AAACN), and the American Organization of Nurse Executives (AONE) each contribute resources for care coordination in the form of position statements, white papers, frameworks, policy briefs, core curriculum, and courses. There are also effective models and tools, along with hospital and community-initiated programs.
Contact center care management is a win-win-win. It’s a win for healthcare systems, the providers (interprofessional team), and most importantly, patients.
Traci Haynes, MSN, RN, BA, CEN, CCCTM is director, clinical services at LVM Systems.