What Is Care Management?

The term “care management” gets tossed around a lot in health care, often used interchangeably with “case management.” At Access East, we prefer it as care management, because that keeps the emphasis where it needs to be — on the patient, and on the care.

A detailed definition might go something like this: Care management is a set of clinical services designed to assist a patient and his or her support system in best managing medical conditions and the behavioral and social problems that can grow out of them, with the multiple goals of:

- Improving a patient’s health status
- Enhancing a patient’s coordination of care
- Eliminating the duplication of services
- Reducing the need for expensive hospital visits

It’s maybe a little easier to think of care management like a wheel, with the patient being the hub. Imagine those clinical services mentioned above as the spokes of the wheel, with the patient at the center, causing the wheel to turn. Every patient’s wheel is a little different, unique to that patient, with some of the services, or spokes, changing from one patient to the next, and some services rolling around more than once, or even multiple times, in the course of each patient’s care.

Care management can include any of the following services, as well as others, as applicable to a particular patient:

Transitional Care

Helping a patient who is being discharged from a hospital in coordinating his or her prescribed course of care at home, and encouraging follow-through of treatment when the patient encounters personal or outside obstacles that discourage success, and that might result in his or her hospital-readmission.

Screenings/Assessments

Our care managers ask the right questions to find out if a patient’s treatment plan is successful, or work with the patient’s care team to explore new treatment options.

Behavioral Health

Assisting the patient with adopting accepted best-practice strategies to advance his or her mental and emotional well-being.

Chronic-Condition Management

Eastern North Carolina has particularly high rates of diabetes, hypertension, heart failure, asthma and COPD, and that’s nowhere more true than among our region’s Medicaid population. All of these chronic conditions can produce ongoing, and escalating, obstacles to a patient’s health improvement, requiring courses of care that address the persistent nature of the illnesses.

Chronic-Pain Management

Chronic pain not only can limit a patient’s activities and compromise the quality of daily life, but can also work against long-term improvements in health, if left uncontrolled. Our care-management teams help coordinate the efforts of pain clinics and primary-care providers to improve patient pain outcomes, focusing with patients on medication reconciliation as well as adherence in following physician prescriptions.

Medication Reconciliation

The process of creating the most accurate list of all medications a patient is taking (to include drug names, dosages, and frequencies and means of administration), and then comparing that list against recent physician orders. Our care managers work with our pharmacists when additional support is needed for medication reconciliation — that is, for making sure a patient is not only taking the right medicines, but that that patient also has no duplicate medications or possible dangerous drug interactions.

Telephonic Care

Telephone follow-ups with a patient to check on health status and adherence to treatment plans, to ensure the patient is understanding and implementing his or her primary-care physician’s prescribed course of care.

Palliative Care

A cross-disciplinary approach to specialized medical care for patients with serious, sometimes terminal, medical conditions. Palliative care focuses on providing patients with relief from the symptoms, pain, and physical and mental stresses of their illnesses.