Case Management Society of America

Features

Standardized Versus Personalized Care Plans

BY JEFF FRATER

Case managers have long been committed to the idea of patient-centric care planning, recognizing the patient as a three-dimensional person with specific needs and wants, strengths and limitations. While provider and payer organizations can sometimes be viewed by patients as faceless monoliths, the one-on-one relationships between care managers and patients have offered a personalized and individualized care relationship to help offset this reality.

It is perhaps for this reason that some care managers may view the idea of standardizing care plans warily, at best. After all, the patients referred to care management are necessarily complex, often with a variety of comorbidities across medical and behavioral health. Treating them with a one-size-fits-all approach would be disastrous. I would offer that the opposite (i.e., care plans and care management approaches that are as numerous as the patients themselves) do not serve our patients nor our profession well.

Care managers should embrace evidence-based care plans as a blueprint for treating complex patients. This blueprint will be shaped by a variety of factors, including comorbidities, demographic and socioeconomic factors, as well as the patient’s ability and willingness to engage in his or her own care.

Benefits to patients

A care plan that uses evidence-based best practices can benefit patients in the following way:

  1. By providing a common starting point for all patients, via a standardized assessment
  2. By measuring patients’ progress both against their own goals and against standardized benchmarks

The care manager who works with a standardized care plan template must incorporate the individual’s needs and limitations. For example, a standardized goal for patients with diabetes might be to achieve an HbA1c of less than 7. However, for a specific patient, that goal may be unrealistic or simply not the patient’s focus. Thus, an individualized short-term goal of 9 percent or the avoidance of severe diabetes-specific complications may be more realistic. In the patient’s terminology, this might mean “avoid dialysis” or “avoid amputation.” In this scenario, the care manager would record the patient’s stated goal as well as the standardized goal while simultaneously tracking progress toward both. Naturally, patients will more actively engage in pursuit of their identified goals.

Benefits to the program and profession

While there is a tremendous amount of evidence-based research to support particular interventions in medical disciplines such as cardiology and obstetrics, a relatively thin body of evidence exists to support certain care management approaches over others. This has to change.

In a time of vast data resources and sophisticated health IT analytics solutions, we need better direction on what works, what doesn’t, for which patient populations and why.

By adopting standardized patient assessments and using standardized goals as a starting point for care plans, care managers can create a wealth of apples-to-apples data that can be used to advance best practices in the field. Increasingly, we may need to demonstrate that experienced care managers cannot be replaced by technology solutions, and that both, working in tandem, is the best way to attain optimal patient outcomes. Data from groups of patients making progress toward standardized goals will contribute to this body of knowledge.

What’s next?

If we embrace the idea that standardization in care management does not erase personalization, a hybrid approach to care plans can continue to evolve with our collective expertise, boosted by technology. Artificial intelligence solutions may help us develop assessments that are akin to “Choose Your Own Adventure” books, leading the care manager down an increasingly precise set of questions based on previous answers. But these complex decision trees will be the same from patient to patient, care manager to care manager, allowing this data to be mined for insights on best practices.

Adding evidence-based content will enrich our care plans, optimize our patient outcomes, and ultimately make our jobs even more fulfilling than they already are now.

Jeff Frater is a former president of CMSA. During his term, he oversaw a substantial revision of the association by-laws and the 2008 update to the Case Management Standards of Practice. He currently serves as senior vice president, Clinical Strategy and Solutions at Zynx Health. In this role, he is primarily responsible for directing the development and delivery of evidence-based clinical solutions to support healthcare organizations’ achievement of their quality and financial goals. Mr. Frater has more than 20 years of experience across multiple healthcare sectors focusing on case and care management, including both commercial and public payers, and healthcare providers along the entire care continuum.