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Managing Meds Through Chronic Care Management


With all of the advances in pharmacology over the years, many diverse health conditions are now commonly treated with medications.It’s possible to take a chronic care patient and stabilize or heal a condition through practical medication regimens, to avoid surgery or other interventions down the line. The power of pharmaceutical care is amazing in many cases. But it also involves a significant amount of work on the part of providers.First, practices have to administer the vast number of drugs on the market, and customize a medication schedule to a particular patient. Also, with chronic conditions like diabetes, hypertension or high cholesterol, there’s the need for consistency in pharma care, where a patient needs a controlled dose on an ongoing basis. For other conditions, patients may have to try a selection of drugs to find the one that works best.All of this puts pressure on provider offices. Time that could have been spent in core clinical work may get taken up with prescription calls, communications with pharmacies, and general administration of medication plans. Refills, referrals and other busywork tend to eat into the practice’s time resources. Ask a busy physician how his or her practice handles on-call hours. You’re likely to get an answer fraught with frustration, or a resigned one that admits a lack of access for patients.

Some offices have taken creative approaches, adding Interactive Voice Response systems for callers, or utilizing Physician Assistants for routine pharmacy communications. Still, too many providers are finding the process of tracking and evaluating patient medication schedules overwhelming. The process of handling patients in between their regular doctor visits gets tough: patients feel like they can’t get a call back, and doctors feel like they can’t get a break.

The Power of CCM Systems

New CCM systems have the power to transform health care, to make things a lot easier for both the patients and the clinical workers who care for them.

One of the most fundamental elements of a CCM EHR/EMR system is the ability to take a lot of the administrative work off of the physician’s plate, by creating a central platform where patients can interact with other care providers. Instead of trying to ring the family doctor’s nurse, patients can use the platform to connect with designated point people who can help them with routine aspects of care – like prescriptions!

Making Care Collaborative

Also, by making all of the chronic care patient’s context information visible, the CCM platform is enabling other kinds of problem-solving. The patient, or a family member, can be active in following progress, looking at when care is administered, and taking into account lifestyle changes that can complement medication or treatment.

This is what experts call the principle of “collaborative care” – new CCM systems take some of the burden off of the doctor, by making healthcare less of a “closed loop” and allowing others to take a look in the window. Again, it’s the same principle of delegation that individual practices might use to triage clinical work – but these systems do it more fully, by taking all of that data and making it more accessible to a greater number of real stakeholders.

State-of-the Art Healthcare Tech

In addition, a lot of the new technologies built into these platforms allow for even more long-term problem-solving, both for individual patients, and for populations. The Internet of Things, for example, helps to achieve models involving plugged-in glucose monitors or blood pressure monitors or other tools that micro-manage patient care in an automated way. These systems can also embrace the cutting-edge principle of machine learning, helping clinicians to draw conclusions about care that would have otherwise been beyond their reach.

Results for Patients and Practices

The kinds of 360-degree, HIPAA-compliant platforms that vendors are offering providers for population healthcare can keep patients healthier, reduce visits, calls and hospital stays, while improving quality of life. A diabetes patient may be able to ask about blood sugar levels and get quicker answers to help with diet questions. A person who is on a blood thinner might be able to more efficiently change dosages, under the care of a qualified medical professional, or get quicker responses to issues that involve managing and mediating tricky dosage levels. A patient who wants to switch medications may get those switches done days earlier – because instead of working through a single, isolated channel with an overworked doctor at the other end, the collaborative process is one where a greater number of involved parties can take action.

New CCM systems are a big step forward in the journey to replace old, rigid care models with others that leverage new technologies to take patient care to the next level.

About Orb Health

Care Management as a Service™ rapidly provides EMR-connected remote contact centers as a scalable virtual extension of the practice to deliver cross-practice scheduling and care management programs as a guided service without adding staff, apps, or infrastructure.

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