Which populations are appropriate for care/case management focus?

Most commonly, patients are identified through predictive risk analytics as potential high utilizers.  These patients are then the focus for case management.  Question for discussion:

  • We would probably expect to use different case management styles (and even tools) for the very high utilizers (e.g, over $50,000 per year) than for the moderate utilizers (e.g., $10,000 to $50,000 per year).  How many “levels” of case management ought we implement?
  • Would we expect to have significantly different interventions between the levels of case management?

Looking forward to comments.

One Response to Which populations are appropriate for care/case management focus?

  1. Robert Friesen says:

    A picture is worth a thousand words or, in this case, billions of dollars. The graph depicting the distribution of spending in healthcare on the “Another View of Patient Stratification Data” web page and the statistics above are yet another illustration that current health management strategies are not working and new ways of predicting and then managing the potential for escalation are the next step. The imperative is clear, tools are there, the return is obvious and compelling – it’s up to some early adopter ACOs to make it happen.

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