As the prevalence and associated costs of chronic diseases continue to grow, healthcare stakeholders, including payers, are focusing on performance and population health program (PHM) measures of chronic conditions for reimbursements and value-based incentives.
Provider groups taking on risk have initiated disease management (DM) programs for patients with common chronic diseases, and complex case management (CCM) programs for patients who experience critical or traumatic health events, or who have highly complex and high-acuity diagnoses. Core to both DM and CCM programs are requirements for care managers to address behavioral health problems or socioeconomic challenges. Effective care coordination programs have the capability to focus on building relationships with patients and primary care providers. This can allow provider groups and payers the ability to demonstrate improvement in preventive care and quality measures.