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Managed care organizations and remote care management: a perfect match
A woman on a laptop

Imagine the scene: you, a care coordinator working for a managed care organization (MCO), are responsible for clients that are notoriously hard to contact or connect with. Your clients are phone-averse, have difficulty with transportation, or are immunocompromised, and coming into the clinic is not the best idea amid COVID-19 restrictions. However, there are meds to be managed, metrics to be collected, and other standards by which you need to abide.

For many professionals working in the MCO world, scenarios like these are extremely common. So how can the average care team remedy these issues? To continue to offer efficient, cost-effective, and accessible care today and in the future, healthcare providers need to use technology to adapt to a structure that enables them to improve care metrics without increasing costs.

Remote Care Management (RCM) is one possible solution. RCM is care delivery that enables providers and care coordinators to use digital technologies to monitor individuals outside of conventional clinical settings. Wide availability of easy-to-use devices to measure vitals, high smartphone penetration, Bluetooth and Cloud technology, etc. make it possible for an individual to measure and record health data at home and transmit it securely to a care provider in a different location for review.

While RCM can bring several benefits to MCOs, the most significant ones might be:

  • Active patient tracking
  • Improved metrics
  • Increased access to care

Active patient tracking: With remote care management, not only can care team staff have a near-constant connection to members and patients under their care, but they can also have more direct access to members’ data. Such access helps care providers stay “in the loop”—monitoring data, metrics, and the regularity of measurements. This, in turn, also gives them the necessary inputs to provide additional education, support, and feedback.

“…healthcare providers need to use technology to adapt to a structure that enables them to improve care metrics without increasing costs."

Improved metrics: RCM can also help improve performance and quality metrics by encouraging patient adherence to the care regimen. RCM tools usually have built-in reminder capabilities. RCM not only allows for a connection between provider and member, but also between members and their respective health data, which plays a role in members feeling empowered and engaged in managing their health. Improved access to care: Another benefit of remote care management is increased access to care. Geographic separation and distances become much less of an issue for members and patients who live in remote, rural areas. Care providers are able to manage higher caseloads due to the reduced need for home visits, thus improving utilization of their resources. As well, hurdles to deploy such care models have been mitigated with changes. For example, in 2019, the Centers for Medicare and Medicaid Services (CMS) expanded the reimbursement code for remote care,1 allowing for more services to be covered. With these potential benefits, remote care management can work well for MCOs when looking to improve member care experiences and enabling healthcare providers to engage in more cost-effective business models.

1mHealthIntelligence (November 5, 2019). CMS Finalizes New Reimbursement Rules for Remote Patient Monitoring. Retrieved March 12, 2021, from https://mhealthintelligence.com/news/cms-finalizes-new-reimbursement-rules-for-remote-patient-monitoring.

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