Care management is proactive approach to health

Over the last three years, Marybeth had been thinking about quitting smoking, but just didn’t get around to it. At her last physical, her nurse practitioner told her that her “bad” cholesterol was too high and her “good” cholesterol was too low. She was supposed to take blood pressure pills but couldn’t find the time to pick up the prescription. She would describe herself as being in good health, except for a handful of days off from her work as a teacher due to her bad cough. Then the phone rang one Saturday morning; it was a “care manager.”

According to the U.S. Department of Health and Human Services, Americans suffer more than 2 million heart attacks and strokes each year, and 2,200 people die from cardiovascular disease every day. Heart disease and stroke are also among the leading causes of disability in our country, with more than 3 million people reporting serious illness and decreased quality of life.

Efforts are underway, with combined forces from both the public and private sectors, to reduce the number of people who suffer from these debilitating illnesses and even die from them. Health plans, provider offices, hospitals and other facilities are using care managers as a resource in a proactive effort to reach people and prevent the consequences of these terrible illnesses.

Care managers, according to the Case Management Society of America, “help provide an array of services to help individuals and families cope with complicated situations in the most effective way possible, thereby achieving a better quality of life. They help people identify their goals, needs and resources.”

One example of a resource is the Million Hearts campaign (millionhearts.hhs.gov), a national initiative that has set an ambitious goal to prevent 1 million heart attacks and strokes by 2017. Care managers use evidence-based guidelines and educational support, and they can refer to tools from the Million Hearts website to help people learn more about preventing heart disease and stroke.

Some people wonder if working with a care manager means they will relinquish control of their health care. The CMSA notes that a good care manager “will work with you to determine what is important to you and what you think would be the most effective way to reach those goals.” Additionally, care managers “don’t manage people – they help people to manage complicated situations. Simply put, they help to keep you, or your loved ones, at the center of services being provided on your behalf.”

Another concern is related to providing personal health information to a stranger. It is important to remember that these are health care professionals who uphold patient confidentiality with the most stringent guidelines.

There are a variety of ways that care managers can reach out to a person. The telephone remains the most prevalent mode of communication. It is private, convenient and inexpensive. More than ever, however, technology is coming into play as another medium. Interactive Voice Response and email campaigns are there to “nudge” us with reminders about screening test. Text-based programs use “gamification” – or text-based games as a fun way to engage in managing care of a chronic condition.

FaceTime-like interactions are also making their way into the health care arena due to improved Web-based security. And “apps” abound in the health care space to assist us with everything from wellness to complex care.

There are also more traditional techniques, however, such as mailed reminder letters and even face-to-face visits in a provider’s office or visits by a nurse in the home.

The evolution of care management is taking shape right now. New efforts are targeted to be more “person-centered” and reach individual people at risk for a variety of issues. Technology is being used more than ever to identify people at risk and to offer new solutions to engage in health care.

Over the course of the next two months, Marybeth spoke frequently with her care manager by telephone during the evening. She identified two goals that were important to her: to finally quit smoking and to eat a healthier diet with less sodium. Using evidence-based guidelines promoted by the Million Hearts campaign, and by setting actionable goals that were important to Marybeth, she was finally able to quit smoking. Her care manager helped her understand and use resources available to help her reach her goals, such as pharmacy benefits and assistance in paying for a fitness benefit and weight management. Her blood pressure came under control and she was able to feel more productive at work as well as at home.