New arrows in the quiver for targeting care management: high-risk versus high-opportunity case identification.
"Care management" purposefully obscures the distinctions between disease and case management and stresses their common features: action in the present to prevent adverse future outcomes and costs. It includes identifying a high-need population by referrals, screening, or data analysis, assessing those likely to benefit from interventions, intervening, evaluating the intervention, and adjusting interventions when needed. High-risk individuals can be identified using at least 9 techniques, from referrals and questionnaires to retrospective claims analysis and predictive models. Other than referrals, software based on the risk-adjustment methodology that we have adapted can incorporate all these methodologies. Because the risk adjustment employs extensive case mix and severity adjustment, it provides care managers with 3 innovative ways to identify not only high-risk individuals but also high-opportunity cases.
Bernstein
Richard H
RH
Mt. Sinai School of Medicine, New York, NY, USA. rbernstein@careadvantage.com
D019090:Case Management / Q000458:organization & administration*; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D020379:Risk Adjustment / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D014481:United States