Care Management Technologies

Care Management Technologies (CMT) harnesses the information
present in modern healthcare databases by applying multiple filters of evidence-driven and expert-based consensus to align care with best practices. CNS’ advantage grows from its validated and extensively published Consensus Guidelines, part of its Expert Knowledge Systems, enabling rapid introduction of new best practices into the integrated pharmacologic, medical, and psychosocial care for individuals with serious, persistent mental illness. CMT applications allow clients to explore analytic and interventional approaches matched to their needs, examining large populations, disease-specific subsets, or individual cases/patients. Such granularity is accompanied by targeted interventions to improve the quality of prescribing, the degree of medication adherence, and the optimal management of complex medical and behavioral cases. All approaches are structured to more efficiently use healthcare resources and in turn, reduce the pharmacy and services spend for those affected by major behavioral disorders.

Strategies to simultaneously improve quality and decrease overall costs for treating patients with chronic mental illness is best directed by those who have substantial experience and dedication to creating effective public policy, personally caring for patients, and discovering and evaluating new treatments for this population. This expertise, guiding the application of technology to improve care and focus clinical interventions where most appropriate, remains a critical advantage inherent to the people and process across CMT and CNS overall.

Whether clients are government entities (State Medicaid and Mental Health agencies), health plans contracted to care for the chronically mentally ill (Medicaid/Medicare Advantage Plans), or disease management partners, CMT offers novel, regularly refreshed analytic approaches that:

Address high-risk practices in behavioral medicine through risk prediction and targeted intervention
Improve overall quality and appropriateness of prescribing practices through best practice education
More effectively integrate medical and behavioral treatment among multiple providers
Reduce pharmacy cost trends and treatment costs
Provide a return on investment within six months

The CNS Difference: Expertise, Technology, and Targeted Persistence

Extensive expertise to support care systems. As an organization dedicated to patients with mental illness in public and private settings, CNS maintains significant insight to develop and evolve indicators of quality, identify care patterns that contribute to poor outcomes, and guide care for serious behavioral disorders within a fragmented delivery system. Information about multiple medication use, high-risk conditions, and care coordination networks optimizes referrals to existing disease and/or care management programs, promoting more effective and efficient use of such programs. With an ever-increasing amount of patient data, treatment options, and evidence-based guidelines, CMT expertise distills multiple sources of information into specific, actionable data in useable formats, vital in better decision-making.

Technologies to apply best practice education to prescribing. Given that direct, controlled comparisons across treatments for behavioral illness are limited in their number and application, the quantification of expert opinion is paramount to making sound informed treatment decisions. CNS’ Risk Prediction Algorithms transform paid medical and pharmacy claims into forecasts of future costs, and guidance around treatment changes which reduce the risk of poor outcomes. Data can be compiled and sorted from almost any medical paid claims file; ordinarily there is no need to restructure data from existing formats or for special reports. CNS’ data management capabilities allow for identification and intervention to improve the quality of prescribing, improve the quality the degree of patient adherence for patients with complex, persistent behavioral illnesses, and provide critical coordination and communication across healthcare providers, enhancing evidence-based decisions with the right data, in the right format, at the right time.

Targeted, persistent, non-duplicative intervention. By isolating and focusing on the differential impact of efforts to improve the quality of care and prescribing, address patient adherence, and optimally coordinate care for those with chronic mental illness, CNS’ interventions sensitively align healthcare professionals with clinical best practices. CMT does not undertake utilization management, but provides efficient, effective change through education, data analysis, and information sharing. By combining pharmacy and medical claims and foundational rules for care, prescribing, adherence management, and care coordination, CNS is consistently identified as a valuable resource across treatment team members. CMT services do not duplicate programs offered by Pharmacy Benefit Managers, Specialty Disease or Case Management Programs, or Managed Behavioral healthcare Organizations, but work in collaboration with health plan and specialty service organizations to integrate data and care across otherwise disparate programs.