Every evening, I close out my workday by reviewing social media for interesting and inspiring posts. And funny memes, I won’t lie. But earlier this week, one post caught my attention. It was highlighting the study "Impact of Complex Care Management on Spending and Utilization for High-Need, High-Cost Medicaid Patients" published by the American Journal of Managed Care earlier this month.

It caught my attention for two reasons, 1) because I believe in the impact of a well-trained care manager on the health of an individual, and 2) because solid evidence supporting dedicated care management has been difficult to find. HealthTeamWorks has experienced success in multiple engagements, but published studies validate our experience.

Now, this is only one study and the authors admit that the impact of care management has been uneven. However, there are multiple factors that contribute to the success of a program including poorly defined objectives, lack of leadership / physician support, and lack of sufficient training for the dedicated resource. Consider the challenges many of the individuals selected for care management experience and the whole concept feels insurmountable. But it’s not.

This study outlines key steps to successful care management:

  • Identifying patients at high risk of poor outcomes and avoidable spending;
  • Conducting comprehensive assessments of medical, social, and behavioral risk;
  • Care planning and routine follow-up;
  • Interdisciplinary, team-based care; and
  • The use of Community Health Workers (CHWs) to engage and activate patients, build trust, and better understand and manage the nonmedical drivers of poor outcomes.

HealthTeamWorks has advocated for implementation of each of these steps, both in our transformation contracts and in our training content. In fact, these elements are key topics in our Essentials of Care Management online training program.

Our focus in on helping the Care Manager understand their role, the difference between episodic and longitudinal care, and how to connect with and engage patients in managing their care between visits. We do not address clinical skills. That’s not our focus and most care managers come to the role with the appropriate clinical skills.

We’ve also come to learn that many participants need the opportunity to learn these concepts incrementally and have the chance to apply them in a real world setting before moving on to the next topic. This is why we offer access to our online programs for a full twelve-months. This allows every individual to learn on their own schedule and at a pace that works for them.

To learn more about the Essentials of Care Management curriculum go to  and email to start your registration process.


Blog written by Kristen Stine, Program Manager - Learning & Diffusion, HealthTeamWorks