11/3/2023 0 Comments Optum quadruple aimThis drives the need to fully integrate disease-specific subspecialization - clinical expertise, data-driven insights, and condition-centric capabilities - when addressing chronic and complex conditions. To address the needs of these patients and their providers, a better approach is to have the depth and expertise to coordinate care delivery, promote greater efficiency and adherence to evidence-based medicine, create higher levels of engagement and satisfaction, align incentives through risk-sharing and value-based contracting with providers, and deploy advanced data analytics to provide stakeholders with real-time feedback on performance and outcomes. With complex and chronic conditions, ongoing care often involves the PCP, multiple specialists, in- and outpatient facilities, and all of the inherent difficulties faced by a patient who must navigate the care and payment systems over an extended period of time. Specialized management of complex conditions To do so effectively, medical benefit management must be as highly specialized as the complex and chronic conditions being managed, using like-specialty medical directors and purpose-built systems and apps to effectively drive the highest quality and efficiency of patient care. It must also be able to help patients and providers navigate, over an extended period of time, across different health systems and frequently incompatible information platforms. Treatments may involve new interventions and experimental drugs, novel ethical considerations and extensive family involvement.Īn effective management approach must be able to address multiple specialties’ distinct practice patterns and rapidly evolving clinical protocols. Because many of these patients have progressive illnesses, long-term health needs and multiple comorbidities, their continuum of care typically involves a changing array of providers from multiple clinical specialties, with services delivered at numerous sites. However, applying medical benefit management to patients with complex and chronic conditions is especially challenging. In fact, general health plan programs work well when managing core services, such as routine elective surgeries and common medical conditions. These strategies are, to varying degrees, used by all health plans to manage covered services. IntroductionĬonditions such as cancer, kidney disease, musculoskeletal conditions and heart disease account for more than a quarter of annual health care costs ($455 billion), with high levels of upward trend.1 Physicians and others involved in managing these complex and chronic medical conditions face special challenges when trying to address rising costs and achieve the Quadruple Aim of better outcomes, lower costs, improved service and higher satisfaction. CMO Vital Views Clinical insights on the challenges, approaches and trends shaping health care.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |