Care Management Contracting for Complex Populations: Best Practices and Tools

Guide
Key Questions Answered
  • What are best practices in care management contracting for high-need, high-cost individuals?
  • What are the different types of contracts?
  • What are the critical elements of an ideal contract process?
Key Themes and Takeaways

This resource reviews best practices in care management contracting based on in-depth interviews with organizations that operate sustainable, effective programs for patients with complex needs. The report and accompanying tool explore different kinds of contracting and offer practical guidance for payers and providers engaging in contract negotiations. Key takeaways include:

 

  • It is critical to identify individuals with persistently high needs and costs, then further segment by need type.
  • Guaranteed access to data is crucial for successful care management, as is ensuring contractual specifications on both the type of data and the frequency with which it is shared.
  • To promote sustainability, a care management program should provide a return on investment (ROI) over the course of multiple years and meet specified contractual targets.
Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Expert Opinion
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