Creating Clinical and Economic “Wins” Through Integrated Case Management

Abstract

The 5% of patients using 50% of health resources commonly have interacting and persistent multimorbid illnesses; concurrent mental health problems; impaired social networks; and/or difficulties in accessing care through the health system. To improve outcomes in these patients, it is necessary to overcome clinical and nonclinical barriers that lead to poor health, treatment resistance, high health care cost, and disability. This article describes an innovative complexity-based and outcome-oriented approach using integrated case management. It helps treating physicians and health administrators understand how to incorporate value-based case managers to optimize care for complex patients while better utilizing resources.

Identification of components of health complexity on internal medicine units by means of the INTERMED method

“…It is based on the assumption that return to health is dependent on altering factors in four risk domains: biological, psychological, social and health system . Each risk variable in the INTERMED was chosen so that, if it is identified as a problem, direct clinical and non‐clinical corrective action can be taken .…”

“…Currently, care providers and administrators largely focus on the presence or number of chronic medical conditions and the costs incurred for health services as proxies for health complexity. The exclusion of psychological, social and health system contributions limits vision about assessment needs and the types of assistance that could be used as part of the intervention/assistance process . For instance, recent studies show that case management has significant potential to help clinicians improve clinical and cost outcomes for patients with health complexity .…”

“…For instance, recent studies show that case management has significant potential to help clinicians improve clinical and cost outcomes for patients with health complexity . In fact, a new integrated model of case management, inspired by INTERMED, which systematically assesses biopsychosocial and health system case management without the need for case manager handoffs , is increasingly being used as an adjunct to standard clinic and hospital‐based care.…”