What are the key elements of a care management plan?

Meet the more than 350 customers we serve, including ACOs, health systems, insurers and more. An example of patient advocacy could be working with a patient who doesn't speak, but who wants an electric chair to move around (for example, ordering and building an electric chair involves many steps and requirements, and patients and their families may not know where to start).

What are the key elements of a care management plan?

Meet the more than 350 customers we serve, including ACOs, health systems, insurers and more. An example of patient advocacy could be working with a patient who doesn't speak, but who wants an electric chair to move around (for example, ordering and building an electric chair involves many steps and requirements, and patients and their families may not know where to start). A care manager can help manage the chair process, including completing the paperwork, communicating with the electric chair company, coordinating payer payments to insurance companies, confirming the level of functionality the chair should have, and obtaining financial assistance. In a job that changes every minute, care managers don't have much time to think when faced with unpredictable situations.

Developing knowledge of the human variables that contribute to the holistic image of the patient is part of the care manager's responsibility. This involves consulting patients frequently and recording data on the patient's progress toward their goals, which will be important in the evaluation stage of the care plan. The care manager's job is to guide patients through the process and to advocate for them throughout the process. An effective care manager fosters relationships with the patient, the management team, and providers at the same time, while ensuring that the patient is at the center.

The care manager must encourage all of these relationships so that the entire team, both clinical and personal, participates in the care plan and is prepared to play their part for the good of the patient. Cultural competence allows care managers to interact positively with patients and understand their healthcare beliefs based on their cultural and religious backgrounds. With patient well-being at stake, care managers must understand the role that data plays in identifying which patients are the top priority that day. Cultural competence and an understanding of the social determinants of health (SDoH) are key elements for successful care management; care managers must master both aspects because they encounter a variety of people from all backgrounds.

Care managers are often faced with the challenge of lack of interoperability due to outdated EMRs and disparity in systems. The purpose of a nursing care plan is to document the needs and wants of the patient, as well as the nursing interventions (or implementations) planned to meet these needs. If organizations don't understand this value, the care manager can create opportunities to educate and inform them. Successful care plans use the fundamental principles of critical thinking, client-centered techniques, goal-oriented strategies, evidence-based practice (PBE) recommendations, and nursing intuition.

Health Catalyst is a leading provider of data and analytics technology and services for healthcare organizations, with a commitment to being the catalyst for massive, measurable and data-driven healthcare improvement. At the core of the care delivery process, care managers address the true complexities of each individual and must bring together all actors in a care plan to help the patient achieve optimal health.

Raven Cardani
Raven Cardani

Lifelong beer advocate. Devoted internet trailblazer. Passionate music maven. General food trailblazer. Subtly charming pizza junkie. Freelance internet buff.

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