Care management is a consumer-centered strategy that provides health plan members, providers, and their support systems with clinical management solutions to enhance health outcomes and reduce costs. To effectively deliver care management solutions, it is expected, if not mandated, that the health care organization use a software system to facilitate the delivery of care management for utilization review, case and disease management, population health administration, and other care coordination options.
There are a number of well-known care management software applications that offer the opportunity to provide well-defined programs and procedures across multiple market environments including, commercial products, CMS, worker's compensation, mental health, and disability plans. Regardless of the type of care management solution considered, it is critical to understand the importance of a well-designed strategy to evaluate and implement new software.
Here is a brief overview of how to avoid the threats and pitfalls of purchasing a care management solution that does not function appropriately to meet your business objectives.
1. Organizational Commitment To The Project
It is essential that there is an executive commitment to the endeavor. Internal alignment to the strategic and financial goals of the purchasing organization ensures that the application will meet the overall business objectives. Management commitment safeguards the integrity and adherence of staffing necessary to evaluate, manage the project, and implement the software. This approach also includes the executive understanding of the staffing time necessary to address the software evaluation, implementation, and training timeframes. Many projects are delayed because the staff is unwilling or unavailable to perform the time-consuming evaluation, extensive training, and engage in the implementations due to their daily workloads. Participation in a care management solution project is often a full-time commitment for essential team members. Therefore, senior management should be willing to facilitate and arrange workload supervision for contributors to the project in order to alleviate absenteeism and enhance participation.
2. Budgetary Considerations
A well-defined budget for the overall software assessment and implementation processes should be in place prior to an initial proposal activity. This allows for more rapid consideration of initial bids and reduces the risk of engaging a technology partner that does not elucidate full-scope pricing. This budget should include direct costs attributable to the time commitments for the team managing the project and any additional staffing necessary to cover the daily roles and responsibilities of those on the project team. The purchasing organization should also derive an understanding the impact of the software on operational changes that may increase direct costs such as higher levels of engagement, the need for more extensive case or disease management interactions, increased use of community resources, IT oversight, etc. These costs are not always offset by improved utilization management automation or staff reductions in operations.
3. Understanding objectives
All participants in the evaluation and implementation process should have a clear understanding of the clinical, financial, and administrative objectives and success metrics for the software being evaluated. Personal agendas create dysfunction across the project team and lead to prolonged evaluations and missed implementation timeframes. This is where a project manager's role is most important in providing consistent oversight and alignment to the executive direction and budgetary restraints. Failure to have an experienced and proficient project lead will increase the potential for a poor evaluation decision and/or a prolonged unsuccessful implementation.
4. Workflow guidance
Prior to initiating an evaluation of a care management solution and again during the implementation process, a clear understanding of the current care coordination workflows, appeals, grievances, policies, procedures, and regulatory compliance factors should be well documented. The healthcare organization will miss significant opportunities for performance and productivity improvements if all potential areas for operational enhancements are not identified - inclusive of integrated workflows to third-party applications which are being integrated into the care management processes. In addition, progress towards NCQA, URAC, or other accreditations will be delayed or failed if the software does not meet and align with nationally recognized standards inherent in the software evaluation and implementation process. Training times for newly designed workflows are often missed and should be included in the process mapping to allow for appropriate staffing management and budgeting.
5. Timeframe management
Experience has shown that healthcare organizations have elevated expectations of rapid and uneventful software introduced into the operational environment. Throughout the software assessment and integration deployment, a clear understanding of realistic timeframes should be developed with diligence applied to “scope creep” and implementation cost overruns. Timeframe management is inclusive of the need to evaluate intervals of data transfers, how and when to perform business-as-usual operations during testing, and other migration issues. Other considerations include timelines for gathering data from integrated third-party applications such as predictive modeling, network administration, credentialing, and social determinants of health collaborations. Frequent steering committee reviews and project management oversight is required to prevent delayed implementations and go-live dates. Communication between the healthcare organization and the software supplier should be frequent and candid.
Ready to take on a new Care Management Solution?
These key considerations for a care management application integration demonstrates the need for a well-designed and highly “hands-on” approach for successful project completion. Many smaller or mid-size healthcare companies have neither the internal expertise nor operational staffing discretion to successfully manage the entire preparation, evaluation, negotiation, and implementation process for software integration. Therefore, these types of organizations turn to external consulting support to control costs and effectively provide project management of what is an expensive purchasing endeavor with potentially significant challenges.
An experienced consulting firm can more effectively and efficiently manage the entire project with an expedited time to value. The consulting organization can help develop the materials and scheduling for the evaluation process, document the required workflows, provide all regulatory, compliance, and accreditation standards, coordinate communications and timeframes, and determine ROI.
Partner with Impresiv Health
If your organization is considering a care management software purchase, Impresiv Health can offer experienced, trustworthy, and credible consulting services to facilitate a successful project outcome. Impresiv has evaluated and implemented multiple care management platforms for nationally recognized healthcare companies and would welcome the opportunity to work with innovative care management organizations.
Connect with us through our website or reach our directly to Chris A. Brown, Chief Growth Officer at firstname.lastname@example.org. We look forward to assessing your project needs and providing you with the most efficient solutions.
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