Integrated medical management

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The goal of “medical management,” an emerging discipline within the health care sector, is to integrate the distinct processes of case management, disease management and utilization management, thereby achieving better clinical outcomes and reduced costs. In the full article from which this summary is drawn, we offer insight into a disciplined, structured approach that will help give health care providers a clear, integrated medical management strategy, an efficient operating model and technology enablers that will enable them to realize the full benefit of their investments in this new field.

Jumping into execution without a clearly defined strategy risks suboptimized investments at best, and an organizational rejection of the concept at worst.

The importance of a strategic approach

A tightly focused strategic plan is an invaluable tool to get an organization focused on delivering large-scale, medical management change.

Such planning exercises have many forms but, at a minimum, should include the following components:

  • Environment scan — what are other health care providers doing in this space? How are patient needs and preferences changing?
  • Current-state review — what is the organization’s starting point and level of maturity in key medical management processes?
  • Scope — where should the organization focus efforts for change and, just as importantly, what areas are out of bounds
  • Objectives — what needs to be accomplished, and how will the organization operate or differ when the objectives are achieved?
  • Initiatives — how do we chunk up the work into manageable projects and when can they each be completed?
  • Outcome metrics — how will we quantitatively know if the organization is successful?

Defining the operating model

In the context of medical management, the end goal is an operating model with highly standardized processes (e.g., executing clinical pathways with minimal unwanted variation), but also highly integrated processes (e.g., clear hand off of patient data from one care delivery team to another). This presents a huge shift for many health care organizations with distributed facilities that operate with relatively low levels of process standardization and integration.

Executing this shift requires a blueprint for the operating model that describes how the strategy will be implemented in the following areas:

  • Process model — how will processes be aligned in support of patient outcomes?
  • Organizational structure — what new roles are required and what are the appropriate reporting lines?
  • Governance — where will the decision-making authority reside for each process within the organizational structure
  • Technology architecture — what new data, systems and interfaces will be required to support the process model
  • Operating locations — what activities will be performed and where, and will any new locations or facilities be required
  • Performance metrics — how will we monitor the processes and then hold people accountable for results?

The complete article was written by:

  • Samuel Hughes
    Principal, Strategy, EY, US
  • Katie Kramer
    Senior Manager, Federal Health, EY, US

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