The ongoing shift to value-based care has placed a significant emphasis on provider performance and outcomes. But with clinical staffing shortages near all-time highs, delivering the right care at the right time – which is the essence of effective care management – is more challenging than ever.
Today, the average care manager can be responsible for up to 200 patients each month, depending on the setting. Physician staffing shortages are projected to reach upwards of 139,000 physicians by 2033.[1] And the shortage of nurses is also growing, with one study reporting that more than 600,000 nurses intend to leave the workforce by 2027.[2]
As the demand for healthcare continues to grow and staffing remains in short supply, provider organizations are continually asked to do more with less. In this environment, finding new and better approaches to care coordination is essential to improving outcomes.
Care management notifications represent one easy-to-implement solution. By notifying providers of clinical events that require timely follow up, these real-time alerts can help reduce costly care gaps, increase clinician efficiency, and optimize financial performance.
Prioritizing Care Management for Improved Outcomes
The premise of care management notifications is simple: Leverage technology to monitor care so scarce clinical resources can be deployed where they matter most.
This is accomplished by prioritizing follow-up after care events that are likely to have the biggest impact on patient outcomes – including hospital admission, discharge, and transfer (ADT) events. Care management notifications prioritize ADT events because the intervention of a physician or care manager during these critical windows of time can play a crucial role in avoiding poor health outcomes.
Here’s an example: Jenny is a 66-year-old woman who has been diagnosed with congestive heart failure (CHF). Although CHF is a chronic condition, her primary care physician (PCP) has prescribed multiple medications to help her manage the symptoms.
During vacation, Jenny ate a lot of high-sodium food and forgot to take some of her medications. Upon returning home, she experienced swelling in her legs and shortness of breath. Since it was a Saturday, she went to the local Emergency Department for treatment.
The hospital admitted Jenny for treatment. But upon discharge, she didn’t receive timely follow-up from her PCP or have a care manager assigned to her. Once at home, she was confused about the medications she was prescribed at the hospital and didn’t realize they might conflict with the prescriptions she had at home.
A few days later, Jenny was admitted to the ED again after she began feeling light-headed and short of breath. Without the appropriate care team involvement, Jenny was readmitted to the hospital and suffered an adverse drug event – circumstances which could have been avoided with care team intervention, prompted by care management notifications.
Leveraging Notifications to Change the Trajectory of Patient Care
How do care management notifications work? First, patient-provider relationships are configured in the notification system. Then, when an ADT event is recorded (e.g. a visit to the emergency room), that patient’s care team is notified in real time.
Using this timely, actionable information, providers and care managers can follow up with the patient at just the right time – improving care coordination while reducing unnecessary hospital readmissions.
In organizations where clinical alerts or notifications have been implemented, providers have witnessed firsthand the impact this information can have – and how it can change the trajectory of a patient’s care.
Here are a few examples:
- Hospital admissions: To provide the best care possible, primary care physicians (PCPs) need to know when one of their patients experiences a sudden injury or illness. But all too often, they can be one of the last to learn that a patient has visited the Emergency Department. Care management notifications alert PCPs when emergent care is provided – enabling timely follow-up to close care gaps and reduce readmissions.
- Inpatient discharge: After an inpatient hospital stay, care management plays a critical role in improving health outcomes and reducing readmission rates. When a PCP or care manager is notified of a patient discharge, they can proactively follow up to discuss care plans, perform a medication reconciliation, and schedule follow-up appointments.
- Transitions of care: When a patient transitions from an inpatient hospital to a post-acute setting, delays in sending patient information are common. Care management notifications equip rehabilitation providers with the data they need to inform a patient’s care plan. Not only does this improve outcomes, but it helps providers stay compliant with CMS regulations.
- Wellness visits: Care management notifications can also be configured to remind Medicare patients of overdue wellness visits, which can help identify early signs of serious health conditions like diabetes and congestive heart failure. This improves the likelihood that a patient will schedule their recommended appointments – including recommended procedures such as mammograms and prostate exams.
5 Benefits of Care Management Notifications
Care management notifications aren’t new to healthcare, but they are underutilized across many hospitals and health systems. By implementing a system like the InterSystems HealthShare Care Management Notifications Solution Pack, hospitals and health systems can leverage real-time alerts to:
- Improve health outcomes: By monitoring a patient’s health over time, providers can quickly reach out after trigger events such as hospitalizations. This proactive approach to care management improves patient adherence to care plans, resulting in better health outcomes.
- Reduce readmission rates: When a primary care provider or care manager follows up with a patient after discharge, it can reduce costly hospital readmissions by up to 50%.
- Optimize financial performance: An increased adherence to recommended clinical guidelines, such as annual Medicare wellness exams, colonoscopies, and mammograms, leads to higher revenue for hospitals and health systems.
- Lower costs: Proactive care management also reduces unnecessary costs incurred by missed appointments, duplicate testing, and adverse drug events.
- Ensure compliance: Care management alerts keep your organization compliant with new regulations, including CMS-9115-F, which requires hospitals to send electronic patient event notifications after a patient’s admission, discharge, or transfer to another healthcare facility.
The Financial Impact of Real-Time Notifications
We’ve addressed how care management notifications can improve health outcomes for patients. But the value of real-time notifications can also contribute to the financial health of hospitals and health systems.
Wondering how much care management alerts and notifications could increase your ambulatory and inpatient revenue? Use our economic value calculator to estimate the impact to your organization’s bottom line by entering the annual number of outpatient visits, Emergency Department visits, and Medicare revenue for your hospital or health system.
Make the Most of Limited Resources
Care management notifications alone can’t solve the staffing shortage. But by monitoring patient needs, they can help the busy staff within healthcare organizations better coordinate delivery of the right care at the right time to the right patients.
Let’s return to our earlier example of Jenny. With care management notifications, her PCP would have been notified of her admission to the hospital – prompting a review of her symptoms and treatment. Then, a care manager could reach out after discharge to explain her care plan, answer any questions related to medications, and schedule a follow-up appointment. Jenny would have avoided a potentially dangerous adverse drug event. And the hospital would have avoided a costly readmission penalty.
Using care management notifications, everyone benefits. Patients experience better health outcomes; Physicians and care managers deliver more efficient care; and provider organizations improve clinical and financial performance.
[1] Howley E. The U.S. Physician Shortage Is Only Going to Get Worse. Here Are Potential Solutions. Time. Published July 25, 2022. https://time.com/6199666/physician-shortage-challenges-solutions/
[2] 1.American Hospital Association. Study projects nursing shortage crisis will continue without concerted action | AHA News. www.aha.org. Published April 13, 2023. https://www.aha.org/news/headline/2023-04-13-study-projects-nursing-shortage-crisis-will-continue-without-concerted-action
[3] Vernon D, Brown JE, Griffiths E, Nevill AM, Pinkney M. Reducing readmission rates through a discharge follow-up service. Future Healthc J. 2019;6(2):114-117. doi:10.7861/futurehosp.6-2-114