Care Management Plus: A Hands-On, Tech-Driven Solution for Older Patients

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Key Questions Answered
  • What’s one evidence-based approach to managing care for older adults with multiple chronic conditions?
  • Is this model a good fit for my organization?
Key Themes and Takeaways

Two-thirds of Medicare dollars are spent on ten percent of older patients who live with five or more chronic illnesses. Effective primary care can improve older adults’ health and manage these costs.

  • Care Management Plus (CM+) is an evidence-based care model developed by Intermountain Healthcare Medical Group. It provides staff training, technology support, and ongoing consulting.
  • At the heart of CM+ is a care manager (typically a nurse, social worker, or physician assistant), who teams up with primary care doctors to serve high-need older patients.
  • CM+ tools include a care manager tracking database, a patient summary sheet, and messaging systems to facilitate communication among the health care team.
  • In peer-reviewed studies, CM+ patients reduced their odds of hospital admission by 24-40 percent and their annual mortality rates by more than 20 percent compared to a control group.
  • The resource includes questions to determine if your organization is a good fit for CM+ and first steps to take if you are interested.
Population Addressed
Frail Older Adults
People with Multiple Chronic Conditions
Level of Evidence
Expert Opinion
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