When a Deeper Level of Care Matters Most

Proactive engagement, holistic care for complex conditions improve outcomes

BRIEFING
October 10, 2019
Vice President and General Manager, Accordant

Watch how Accordant nurse Bonnie helped Cathy better manage her condition journey.

Maintaining health with rare or complex conditions often presents a challenge. Patients can feel overwhelmed by the condition, medication side effects, complex dosing instructions, comorbidities, complicated provider directions, and trying to navigate the health care system.

Research shows that half of all patients leave their doctor’s office without understanding what they have been told and a third of adults lack sufficient health literacy to effectively care for themselves.www.ncbi.nlm.nih.gov/pmc/articles/PMC2254573/; www.ncbi.nlm.nih.gov/pmc/articles/PMC1681370/. 

In addition, half of all patients risk increased complications because they don’t take their medications as prescribed, and 40 percent may make self-care mistakes because they misunderstand, forget, or ignore health advice.www.ncbi.nlm.nih.gov/pmc/articles/PMC2254573/; www.ncbi.nlm.nih.gov/pmc/articles/PMC1681370/.,health.gov/communication/literacy/issuebrief.

Care of patients with rare or complex conditions costs four times more than the average patient and twice as much as those with a common chronic condition.CVS Health Analytics. A care model based on support from nurses and pharmacists with disease expertise that supports the whole person and helps address their unique needs can help improve outcomes, as well as help control costs for payors and their plan members.

1 in 3 visit the ER or are hospitalized each year 1 in 5 are readmitted within 30 days 3 in 4 have at least one comorbidity
1 in 3 visit the ER or are hospitalized each year
1 in 5 are readmitted within 30 days    
3 in 4 have at least one comorbidity

Case Management vs. Care Management

Traditionally, one of the ways to help manage a complex condition has been problem-focused case management. But with a greater understanding of the challenges patients face, a new approach has emerged that offers a broader, ongoing array of interventions, known as care management. While the specific definitions of case versus care management can vary, there are some fundamental differences.

Case management is typically short-term, single-issue focused, or episodic support provided by a nurse or social worker – sometimes mental health counselors – to transition a patient from hospitalization to home, or work through barriers raised in an episode of illness where there is a high cost or utilization. The focus is typically on managing a specific disease, issue, condition or event, and eliminating noncompliance and overutilization. The scope is typically defined by the care provider.http://hin.com/blog/2013/12/12/care-vs-case-management-7-structural-differences/.

By contrast, care management considers the person and his or her circumstances as a whole for intervention by a team of specialized practitioners. It is a longitudinal and holistic approach based on understanding the underlying dynamics.http://hin.com/blog/2013/12/12/care-vs-case-management-7-structural-differences/. Care management can address acute care needs but focuses on evolving issues to prevent avoidable adverse clinical and utilization outcomes proactively. Care management also means advocating for the patient with the aim of promoting better quality of life, improving care coordination, meeting the patient’s needs, helping them achieve their health goals, being aware of social determinants of health, and lowering overall costs for payors and members.

A care management team helps the patient navigate managing a complex condition for immediate needs and over the long term. The team provides education, targeted support and intervention aimed at helping patients effectively self-manage their condition to avoid complications.

Care managers engage regularly with patients, caregivers and family members, and they partner with physicians and other providers to help close gaps in care, as well as help them access the resources they need, and answer health and benefits questions. Care management can help complement the support provided through an existing case management program and be an effective strategy to further improve overall member health and outcomes.

The Accordant Care Team Approach

The Accordant program offers holistic support for members with rare conditions through targeted interventions designed to meet each patient’s unique needs. The specialized care team is composed of registered nurses, pharmacists, social workers, and a medical director – all backed by a medical advisory board. These skilled practitioners set mutually agreed-upon health goals with the patient, discuss symptom management, explain proper use of medications, and even deal with resource issues such as lack of transportation to doctors’ appointments or cost of care. Social workers help patients with community resources such as negotiating utility bill payments, identifying support groups, and grants for home modifications. The more than 30 physicians on our medical advisory board are available to Accordant nurses to discuss complex situations and offer insights into care approaches that the nurse may use in supporting the patient. And all of the team’s care is grounded in the latest evidence-based medicine and clinical guidelines.

AccordantCare Patient SatisfactionAccordant Care Management Member Satisfaction survey, August 2019.

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92% agree Accordant helped them understand and follow doctor’s advice

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96% are satisfied with service

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91% agree the program helped them set health goals and make good choices

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95% are satisfied with help they received managing their conditions

Accordant care teams use electronic health records (EHRs), including Epic, the largest EHR system in the country, to identify, prevent and address gaps in care. Care teams receive real-time alerts if members are hospitalized. When the member is discharged, the team can help ease the transition back home by ensuring that all the discharge instructions are clear and that follow-up care is executed as ordered, including follow-up appointments.

Accordant care teams also utilize a robust suite of digital tools and clinical analysis that offer members personalized care. Members can exchange secure messages with their registered nurse care manager via MyChart when it’s most convenient for them. Members can also find support and information through the library in MyChart.

While the conditions that Accordant nurses work with are rare and/or complex, their expertise in these conditions is informed and expanded by the frequent, proactive phone discussions they have with patients rather than reviewing a checklist of questions. These interactions ensure care team nurses have familiarity with, and a deep well of knowledge about, each patient’s situation so they can offer tailored advice and interventions. Nearly all patients recently surveyed said their program nurse was knowledgeable, respected their needs, explained information clearly and answered their questions. Respondents said their knowledge of their condition increased by 12 percentage points after receiving care from Accordant.Accordant Care Management Member Satisfaction survey, August 2019.

24% decrease
in hospitalizations
8% reduction
in ED visits
$2.7K savings
24% decrease in hospitalizations
8% reduction in ED visits    
$2.7K savings

Another way Accordant delivers value is by tracking the clinical metrics of all members with rare diseases. Applying the understanding garnered from measurement data, such as adherence to care plans, completed tests or doctor visits, helps us improve care. Patients whose conditions are not well managed or who are not adherent to their treatment regimen can have higher costs from acute clinical events such as hospital admissions/readmissions and emergency department (ED) visits. A single ED visit can cost an average of $1,900 and the average daily cost of a hospital stay is more than $5,000.https://www.beckershospitalreview.com/eds/cost-of-er-visits-increased-31-between-2012-16-5-findings.html.,https://www.statista.com/statistics/312022/cost-of-hospital-stay-per-day-by-country/. And health episodes are common in this population, with one in three visiting the ED annually. Accordant care teams can help avoid these situations and better manage conditions by tracking patient data and health events.

Applied jointly, all these strategies, combined with support by an Accordant care team led to a 24 percent decrease in hospitalizations, an 8 percent reduction in ED visits and a savings of $2,700 per engaged member per year.Accordant Data Warehouse, Accordant Health Services Book of Business, 2016 claims data.

Want to learn how your members with complex conditions can benefit from our holistic care management approach? Ask Us
BRIEFING
October 10, 2019
Vice President and General Manager, Accordant

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The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.

Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request.

Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.

Accordant Health Services, LLC is not an insurance company or claims administrator. Content provided by Accordant Health Services, LLC, Copyright 2019. Accordant Health Services, LLC, a CVS Caremark company. All rights reserved. Accordant Health Services, LLC is a wholly owned subsidiary of CVS Caremark. Additional financial information is available upon request. Our program, care team and care managers do not provide diagnostic services or direct treatment or care. We assist members in getting the care they need and our program is not a substitute for the medical diagnosis, treatment and/or instructions provided by their health care providers. Our employees are trained regarding the appropriate way to handle members’ private health information.

Image source: Licensed from Getty Images, 2019.

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