New arrows in the quiver for targeting care management: high-risk versus high-opportunity case identification

J Ambul Care Manage. 2007 Jan-Mar;30(1):39-51. doi: 10.1097/00004479-200701000-00007.

Abstract

"Care management" purposefully obscures the distinctions between disease and case management and stresses their common features: action in the present to prevent adverse future outcomes and costs. It includes identifying a high-need population by referrals, screening, or data analysis, assessing those likely to benefit from interventions, intervening, evaluating the intervention, and adjusting interventions when needed. High-risk individuals can be identified using at least 9 techniques, from referrals and questionnaires to retrospective claims analysis and predictive models. Other than referrals, software based on the risk-adjustment methodology that we have adapted can incorporate all these methodologies. Because the risk adjustment employs extensive case mix and severity adjustment, it provides care managers with 3 innovative ways to identify not only high-risk individuals but also high-opportunity cases.

MeSH terms

  • Case Management / organization & administration*
  • Disease Management*
  • Disease Progression
  • Humans
  • Risk Adjustment / methods*
  • Risk Assessment / methods
  • Severity of Illness Index
  • United States