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What Is a Care Manager?

Many assume a care manager is simply a nurse, but that's not always the case. Care managers can be nurse practitioners, physician assistants, clinical nurse specialists, health coaches, and certified nurse-midwives. The distinction of care manager is more about the position's responsibilities - not the level of medical training. Learn about the role of a care manager and how they can be vital to your practice's health outcomes.

What Does a Care Manager Do?

A care manager is an integral player in a care plan, and they must manage various responsibilities to maintain effective care initiatives. While some of these responsibilities have clear directives, other aspects of care management can be more subjective and require strong judgment calls.

Assess Patient Needs to Develop a Care Plan

Physicians are usually responsible for determining medical treatment for a patient, but this is only a portion of care. A care manager assesses a patient's needs beyond a physician's orders to develop their care plan.

For example, a care manager will find out about a patient's access to transportation and how they'll get to their appointments. They may also work with them to find the best way to get their medications as well as build systems for following through with their treatment - the key to improving care outcomes.

Monitor Treatment and Care

On a basic level, a care manager monitors the treatment and care of a patient. This coordination typically involves calling a patient regularly to discuss their current treatment plan, and how the patient feels about the treatment and its results.

The monitoring process includes various functions. During these regular phone calls, a care manager will:

• Educate the patient on their condition(s).
• Review medications and symptoms.
• Perform health assessments.
• Set personalized care goals.
• Answer any questions a patient has.

Care managers need to be mindful of what patients may not say. While some patients can be open about their experiences with a treatment plan, a patient might show signs of challenges without addressing them directly - like struggling to pay for groceries.

A care manager needs to be attuned to these possibilities to monitor risk factors and provide support where patients need it.

Build Patient Relationships

In a study of nurse-patient relationships, researchers revealed that the right type of relationship drives positive care outcomes. In particular, this relationship should involve an equal distribution of power between patient and nurse - both parties should feel equally dedicated to the treatment and take an active role.

The same is true for care managers. While managing care is the core of a care manager's responsibilities, building strong patient relationships is essential for effective treatments. Patients need to feel valued and respected during their treatments, so they feel empowered to be active in their care.

Rather than taking a parental role, care managers act as partners in treatment to keep patients connected to their treatment and drive positive care outcomes.

Connect Patients With Necessary Support

In addition to building relationships with patients, care managers must connect them with the support they need outside of the medical setting. The success of a treatment program depends on the social determinants of health (SDOH) as much as medical intervention.

SDOH can account for 30% to 55% of health outcomes. These determinants include factors like neighborhood, community, economic status and access to education. Care managers need to have an acute awareness of SDOH to give patients the best chance with their treatment.

For example, if a patient exhibits food insecurity based on their location or income, a care manager can connect them with a food bank to get them the nutrition they need. Care managers may also interact with approved family and friends to develop a reliable social support system for the patient as they undergo treatment.

Interact With Care Providers

Care managers must build relationships with physicians and other care providers at the practices they work with. A care manager can be an internal employee at the practice, but it's common to be an external hire, so it's important to determine how to best manage practice interactions.

For example, care managers might look into a patient's insurance coverage to find that they're eligible for prescription delivery. Building relationships with care providers is a matter of defining systems for scenarios like this. Is the care manager able to change a patient's pharmacy themselves, or should they ask the clinicians to make these changes?

Perform Administrative Duties

As with many other jobs in the healthcare field, care managers are responsible for various administrative duties. When confronting legality concerns, insurance coverage and other factors, documentation is critical for providing safe care within a patient's coverage.

One of the primary administrative responsibilities of a care manager is charting information following a patient call. Here, care managers must document everything they've learned, including any possible risk factors in treatment and changes to the care plan.

Billing processes are another administrative detail. A care manager needs to have a strong understanding of the billing codes relevant to their patient calls to get the allowable coverage for the services. It can help to have software in place for managing these codes.

The Role of a Care Manager in Chronic Care Management

Chronic Care Management (CCM) is a program created by the Centers for Medicare and Medicaid Services (CMS) that focuses on managing chronic conditions outside of regular office visits. Care managers are essential players in CCM because they drive the patient interactions that fall under CCM programs. With CPT Code 99490, care managers provide 20 minutes of non-face-to-face interaction per patient per month.

If patients need more care and care managers provide 20 extra minutes of support beyond the initial 20, your practice can bill CPT code 99439. 99439 can be billed twice for patients who require 60+ minutes of care.

At ChartSpan, we act as a CCM partner with our Nurses-First staffing model. Our nurses and clinicians serve as care managers for your CCM patients to improve patient retention and care outcomes. With the help of our software, our nurses and clinicians can effectively manage communication with providers while checking in with patients about their care.

Learn More About Chronic Care Management Solutions From ChartSpan

CCM programs are valuable to patients, especially since almost 60% of adult Americans live with at least one chronic disease. Treating chronic conditions involves far more than getting the appropriate medications. Patients need to take an active role alongside a care manager that's dedicated to their care outcomes.

With the right care managers in your CCM program, you can increase patient retention, identify gaps in care, improve outcomes and increase revenue for your organization with CMS billing codes.

At ChartSpan, we deliver the support you need for an effective CCM program. Our Nurses-First model provides dedicated care managers to help your practice manage chronic conditions, while our software supports correct billing procedures for driving revenue.

Get in touch with us today to see what ChartSpan can do for your practice.