What Is The Role Of A Patient Care Manager In Healthcare?

As patient care managers serve multiple purposes from clinic to clinic, this position is an upcoming trend in medical practices, especially since the COVID-19 pandemic. Are you wondering what they do precisely? Let's take a quick look at their role and the value they bring to this healthcare sector.

Who is a patient care manager?

 

The role of a patient care manager is to remain the significant point of contact between the patient and physicians.

 

Why does a practice need a patient care manager?

 

According to the 2018 research study published in the International Journal of Environmental Research and Public Health, chronic diseases are among the most common and expensive health conditions in the US. Approximately 45 percent of all people in the US suffer from at least one chronic illness, which is on the rise. 

Chronic conditions vary from physical issues like diabetes, obesity, hypertension, etc., to behavioral or mental health issues like depression, stress, anxiety, etc. Care management for these chronic conditions will differ from the treatment options for acute conditions.

Chronic care management involves a mix of short-term and long-term care plans, which are often voluminous. It needs a collaborative service from multiple providers.

Timely access to high-quality care for everyone is essential. However, it's more important to focus on taking care of patients with comorbidities who require additional support. That's where a patient care manager identifies those people and supports them with personalized treatment plans to improve their health outcomes.

Care managers develop personalized care management plans for patients. Their tasks include updating electronic health records (EHR), coordinating treatment options, offering support for self-management, etc. They may even work with insurers to establish coverage for their patients.

In the absence of a patient care manager, the above duties are fulfilled by nurses and social workers. 

How do care managers differ from nurses and social workers?

 

A well-trained patient care manager, unlike nurses and social workers, dedicates more time to taking care of patient needs and provides enough support to healthcare providers.

Practices involving a patient care manager have a higher percentage of patients with a significant improvement in health outcomes than those without.

Does every practice require a patient care manager?

 

Factors such as the size of the practice, the type of patients, and the number of employees determine whether your clinic requires a care manager.

If you’re treating patients with chronic illnesses such as obesity, diabetes, COPD, cancer, etc., you need a care manager. However, specialists who treat acute conditions do not need a care manager. 

Smaller practices may not have adequate resources to support a care manager on their payroll. However, practices having enough resources do not need a care manager. 

So, make sure to identify your needs before considering a patient care manager as they work in medical practices with specific patient profiles.

If your practice deals with senior citizens, your care manager should be trained in geriatric care and nursing and have adequate experience working with older patients and their care providers. 

Suppose your practice deals with children or toddlers; choose the care managers trained in pediatric care.

Care managers work with the physicians to implement care management plans, help patients set and achieve health goals, develop community resources, education materials, and so on.

If physicians don't have adequate time for detailed assessments of patients, care managers could be the right mediator for patient communication. Patient care managers can get patients to open up about their problems and symptoms.

Although treatment and medications involve the physicians, there are many other aspects where just the care manager can help manage the patients' chronic conditions.

If it is possible to include a care manager on the payroll, don’t hesitate! This step can indeed make a significant difference to your patients as they act as a bridge between you and your patients.

What are the responsibilities of a care manager?

 

A patient care manager is responsible for:

  • Building a good relationship with patients

  • Coordinating medical treatment that includes clinical assessments, care plan development, monitoring medication adherence, and more

  • Bringing more value to the practice

  • Connecting patients with community circle groups for a continuum of care

  • Performing administrative duties
     

Build a great relationship with patients

 

Getting a patient to be open is the biggest challenge. This is where strong relationship building comes into play. The majority of a care manager’s day is spent on the phone with patients discussing their chronic conditions, managing health objectives with comprehensive care plans, and getting to know the patient.

It's not possible to bark out orders. Care managers should make patients feel equally concerned and involved in achieving health goals. Especially when the patients are in denial about their own chronic conditions, developing a harmonious relationship with the patient becomes an arduous task. At the end of the day, a care manager should be a real teacher and cheerleader. 

Coordinating medical treatment and care

 

The following important part of a care manager's role is the coordination of patient care. A patient may not tell you everything. It's their job to spot red flags in the medical record and notify the treating physicians before they become something more serious. So, this is the most rewarding part of the care manager profile, where you can feel a real sense of pride in your work.

Each red flag you grab early, each hospitalization you avoid, gives them a sense of accomplishment while developing a caring bond with the patients. 

Even if patients remain reluctant to schedule their own appointments for consultation, care managers can schedule appointments on the patient’s behalf.

At the end of the day, care managers ensure whether the patient's chronic conditions are appropriately managed.

Bring more value to the practice

 

Since the Centers for Medicare & Medicaid Services (CMS) began paying for chronic care management (CCM) services in 2015, CCM has revealed significant growth. The COVID-19 condition skyrocketed the demand for patient care managers.

Physicians have not only seen an improvement in revenue but also an increase in patient satisfaction scores while reducing medical costs and hospitalizations for patients. Many of these benefits are achieved due to the hard work of the patient care managers. 

Connecting patients with the suitable social and community support systems

 

Many healthcare problems, especially mental health issues, are exacerbated due to an inability to get adequate support to keep the health condition in control.

To avoid this issue, care managers should encourage their patients to report problems they are undergoing without this support. The timely support that the patients receive between calls with care managers plays a crucial role in maintaining proper physical, mental, and emotional health.

Performing administrative duties 

 

Last but not least, the administrative tasks of care managers shouldn’t be overlooked. Suppose a care manager takes 10-15 minutes for calling a patient, followed by adding another ten more minutes for charting; consider how efficient they should be while managing care for a minimum of 200 patients per month.

This is where care managers should have comprehensive and intuitive care management software to maximize their ability to perform well. This software can significantly automate many processes, like reducing the time spent managing patient care.

Why hiCare Chronic Disease Management Solution?

 

Our hiCare Chronic Disease Management Solution is an easy, automated, powerful, and customizable patient care management platform that can significantly improve clinical outcomes, increase productivity and reduce costs through a feasible SMS/phone call + web service platform.

Our hiCare Chronic platform includes the following features:​

  • ​​HIPAA compliant secure, and reliable platform​​

  • ​​Easy integration with your existing systems

  • ​Multiple texting solutions starting from appointment reminders to surveys and much more

  • A patient engagement using email, phone, chat, text, in-app messaging, and video

  • Scalable and easy to use cloud-based software

  • Comprehensive care plan for every patient

  • Billing and claiming features

  • And more

 

Having such intuitive software can help care managers to focus more on patients without feeling burdened by their administrative duties.

Closing Thoughts

 

Summing up, a robust patient care management system streamlines the workflow by helping care managers keep track of their patient's health conditions, highlighting red flags, prioritizing tasks, and updating care plans.

So, having a comprehensive patient care management system is the need of the hour to improve timely care delivery and efficiency. 

Learn how hiCare Chronic can help optimize the care of your caregivers while improving revenue for providers. Would you like to deploy patient care management software? Feel free to reach our Hifinite team for a free demo.

References

 

Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018; 15(3):431. Published 2018 Mar 1. doi:10.3390/ijerph15030431 (Link)

Patient Care Manager Role