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Care Management

Galen M. Metz, FLMI, AIAA, AIM, ACS

Posted by Galen M. Metz, FLMI, AIAA, AIM, ACS
February 2, 2018

The next phase of the Electronic Health Record (EHR) continuum is Care Management.  How does an organization address helping the patient choose care options based on quality and cost? How can transitions (handoffs like from hospital discharge to primary care) be improved? What can at-home health monitoring devices offer?In the early days of investing, 401K portfolio management was done 100% by the financial organization. Then came Do-It-Yourself investing via online tools, where the investor took control and could make his/her own financial decisions and portfolio adjustments. A colleague of mine in the 401K investment company called this, “enabling people to make bad decisions faster.”  Now organizations like Schwab and Fidelity have introduced human financial advisors back into the equation. 

I see this same pattern in healthcare. First the decisions were solely made by the physician, then later the patient participated in healthcare decisions, and now evolving to a care management model. In the care management model, a trusted advisor helps the patient make good decisions about treatment options, hospital choices, and healthcare costs. In the care management model, a trusted advisor helps the patient make good decisions about treatment options, hospital choices, and healthcare costs.jpegThis is a vision for healthcare. It may be happening in some instances today, but I see care management growing due to the availability of EHR information and the complexity of healthcare navigation. 

Why is Care Management important?   

  • Improve Outcomes. By providing information to guide the patient in making good healthcare decisions, outcomes can be improved. Consider the advantages of knowing the track record of one hospital versus another on an upcoming surgery you need. Would you prefer a facility that has performed this surgery many times versus one that has rarely performed it, for example? A care management function would assist the patient by providing such data to help make a good decision.
  • Reduce Costs. When you need knee replacement surgery, would you appreciate knowing that one hospital’s cost is $17,000 and another is $55, 000? A care management function would assist the patient by providing such data to help make a good decision.

On handoffs, care management would oversee the handoff process, to make sure the instructions were known to the patient and the receiving provider (primary care, physical therapy,…), plus contact the parties to assure the instructions were followed. This could avoid costly complications due to instructions being ignored. 

Growing Consumerism. Navigating healthcare decisions and finances is complicated for patients, even those with technical prowess. Wading through options, and considering various aspects that impact such a decision, can be frustrating. Care Management can be a life line to the patient, and the right thing to do to help the customer. 

6 Key Steps to Care Management Effectiveness 

How does an EHR enable Care Management? Here are key Care Management functions facilitated by an EHR: 

  1. Using the EHR data, the Care Team can quickly identify the most severe cases: those with the highest risk and the highest potential cost.  The Care Team may be alerted by triggers in the system, by referrals from the physician, or by EHR analytics. The quicker the Care Team can take action, the greater the impact on outcomes and cost.
For example in 1985, I led an excellent IT team that built such a system, to quickly triage and track care management cases. Back then, we saved $4 million in first year from these care management capabilities. 
  1. With opportunities triaged, Care Team personnel are quickly matched to cases and involvement begins. Based on the magnitude of the case load, some opportunities may be outsourced to keep up. With the savings involved in triaged cases, the return on investment (ROI) of outsoEHR enables care to be collaborative and consistent.-1.jpegurcing is often straightforward. 



  1. Individual Care Plan. Combine EHR data with data from other sources to create an individual care plan for the patient. This outside data may be 3rd party, accepted standards of care, for example. Where there are choices, help the patient navigate treatment options, providing data and recommendations (e.g. at home care vs. inpatient). Discuss deviations with the physicians involved. The goal is reducing cost without sacrificing quality. 
  1. Once the plan is established, have this care plan be available to not only the Care Team, but the physicians involved in the patient’s care as well. Consider having this individual care plan be available through the EHR or via a link from the EHR. This visibility helps coordinate care between physicians. Such coordination is critical to Accountable Care Organizations (ACOs) achieving their objectives. Care Management can help. 
  1. Patient Accountability. The Care Management team follows up on the individual care plan, calling the patient to assure prescriptions are being filled and taken as prescribed, to assure the patient is going to physical therapy as directed after surgery, and so on. Care Management records and tracks how well the patient is following the plan. In one example, the follow-up call saved a life, dispatching help to a patient experiencing insulin shock. 

Care Management records and tracks how well the patient is following the plan.jpeg

With the introduction of home medical devices, Care Management can play a role in monitoring device readings, especially checking for abnormal readings that warrant intervention. If the devices can support this monitoring-by-exception, so much the better, as Care Management time is not absorbed by readings that are within acceptable ranges and require no action. 

  1. Update the Care Plan. As the results are monitored and the needs of the patient are factored in, Care Management can adjust the individual care plan.  The visibility of the plan enables physicians to view these updates.  


Having experienced and supported Care Management in several organizations in my career, the improvement in healthcare quality is significant. The dollar savings, too, can be significant, in the range of half a million to one million dollars per care manager.


Next Time: We will explore the topic of Upgrades, the next step in the EHR Continuum. How does an organization address keeping the EHR up-to-date? How does it assess and add new functionality from the EHR vendor?

CIO Graphic - Upgrades.jpg

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Galen M. Metz, FLMI, AIAA, AIM, ACS

Galen M. Metz, FLMI, AIAA, AIM, ACS

Galen is author of • Secrets of Healthcare IT Revealed ( • If You Give a Mouse an EHR – A Parody ( • The Holistic CIO ( He retired after 30 years of healthcare IT management. Previously Galen served as CIO of Group Health Cooperative in Madison, Wisconsin, with responsibilities for the electronic medical record system, health insurance system, self-service web and mobile solutions, business intelligence, and technology infrastructure. Galen is also a professional magician, specializing in close-up magic. The relationship between technology and magic was observed by Arthur C. Clarke, who wrote, “Any sufficiently advanced technology is indistinguishable from magic“.

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