Key features of healthcare case management software

EHR integration

The EHR is the source of truth for every patient encounter. As such, EHR integration is essential for nearly every other health IT solution, including case management software.

Notably, connecting to medical records limits duplicate data and provides access to real-time patient updates. Case managers need patients' clinical information to guide their own clinical decision-making and care plans.

On the flip side, interoperability with the EHR allows clinicians to assess the wraparound care that case managers provide their patients.

EHRs are standalone products, meaning that integration and interoperability are paramount. Some EHR vendors have care coordination tools that can serve as case management software. However, for organizations that are shopping for specified case management software, looking for FHIR/HL7 compliance and APIs will be essential.

Care coordination workflow and automation

Care coordination systems allow case managers and other members of the care team to delegate tasks and communicate. This is essential as healthcare involves numerous healthcare professionals and clinicians.

Through automated care coordination workflows, a case management software system should be able to assign tasks to different members of the care team, transmit patient data, generate discharge plans, facilitate transitions of care and streamline follow-up care.

These systems can, in many cases, serve as case management tools. Through APIs and other integration standards, they can also flow into healthcare case management software suites.

Risk assessment, predictive analytics

Risk assessment tools are integral for modern healthcare case management systems because they allow users to flag patients who need enhanced or altered clinical care plans. Using predictive analytics, these features allow case managers to identify patients at risk for certain healthcare events.

Case management software needs ample patient data to make use of predictive analytics. In addition to the EHR data these systems rely on, case management tools use patient checklists, questionnaires, social determinants of health surveys and patient intake information.

Algorithms within the case management software mine the data to inform risk mitigation planning and assess risk severity.

Utilization management capabilities

Among the many parts of the healthcare case manager's job description is helping to coordinate utilization management. This includes step therapy plans and prior authorizations. Relatedly, case managers are often in charge of coordinating appeals to utilization management requirements and overall claim denials.

The ability to coordinate with hospital billing software is core to case management tools. Additionally, systems that streamline automated prior authorizations and appeals are key.

SDOH referral systems

Because healthcare case managers help patients navigate both their clinical needs and their health-related social needs, the systems need to integrate social determinants of health referral systems.

In some cases, these systems can help screen for common SDOH. They can also help case managers identify social services to help address a certain SDOH, connect or refer the patient to a social service and track patient access to the services.

Patient engagement tools

The functionality to support patient engagement is also critical for healthcare case managers, especially as they work alongside patients and their families navigating an episode of care.

Integration with the patient portal, patient intake services, appointment scheduling tools, specialist referral systems, and secure direct messaging capabilities allows case managers to work alongside patients. Organizational leadership should ensure that case management software allows encryption, especially for secure direct messages, and is HIPAA compliant.

As noted throughout, hospitals and health systems often own patient engagement tools outside of the care management platform. APIs and other integrations will be key to a seamless end-user experience.

Real-time patient monitoring

In addition to patient engagement, case managers also need the ability to track and monitor patient outcomes in real time. Case managers should look for software with capabilities for remote patient monitoring, medication management and telehealth.

Indeed, not every case manager software suite includes these tools, or a healthcare organization might employ these technologies on a more ad hoc basis. For example, an organization's telehealth platform might be bundled with its EHR system, or the organization might purchase a platform foremost intended for clinician use.

In these cases, it will be important to consider a case manager software suite that allows for technology integrations. Tools that allow for APIs to enable a plug-and-play approach to real-time patient monitoring will be key as case managers track patient progress to guide clinical decision-making.

Reporting and performance metrics

Case management software must be able to create reporting dashboards to help case managers detect trends in patient outcomes. Viewing such trends is key for guiding clinical decision-making and meeting quality reporting requirements.

Reporting and performance dashboards need to include information about certain KPIs, such as medical readmissions, satisfaction with the case management program, individuals who refused medical case management services and complaint response times.

Healthcare organizations and case management departments should look for case management software that can track reimbursement and costs in alignment with the industry's overall goals for value-based care. Customized workflows for value-based care are also key.

Hospitals and health systems will want a product that can customize dashboards to their needs. This will help case managers and department leaders tailor insights to their specific patient populations, maximizing the tool's value.

Customization and scalability

Alongside each of these capabilities, healthcare case management software needs to be customizable. For example, a behavioral health practice will need capabilities, templates and workflows different from those of an occupational therapy office. Case management software vendors should design systems that can be customized to the unique needs of various healthcare providers.

Moreover, software systems that are designed to be scalable are essential for growing healthcare organizations. Stakeholders should look for software solutions that can accommodate larger patient caseloads and new workflows. Specifically, they can look for modular design and a cloud-based infrastructure.

Mobile optimization for remote work

Healthcare case managers do not always work tethered to their desks. Because they work directly with patients or caregivers or even out in the community, they need systems that are mobile-optimized and designed to accommodate remote work.

Mobile optimization, such as offering platforms via desktop apps, browser versions and mobile apps for smartphones or tablets, is key for supporting the real-time patient updates that case managers need for clinical decision-making.

Software developers should consider a responsive design that adjusts fonts based on device, user-friendly navigation and offline functionality.

Key takeaways

Because the job function of a healthcare case manager is broad and often overlaps with other healthcare roles, the software these professionals use needs to have numerous key functions.

Not every healthcare case management tool will have all of these features. Moreover, some healthcare organizations might employ separate tools to support certain tasks in other departments.

To that end, leaders should consider the following when selecting case management software for their healthcare organizations:

• Which features are most important to the organization's overarching patient goals?
• Which technologies does the organization in another product? Can the case management software integrate that tool through an API or other process?
• Can the case management software integrate with the organization's EHR? Is it HL7/FHIR compliant, or does it meet other health IT standards?
• Is the system HIPAA compliant and encrypted to ensure patient privacy and fulfill other regulatory standards?

As healthcare organizations continue to streamline the complexities of patient care, case managers will become more essential. Organizational leadership needs to assess their current systems and their purchasing options to ensure technologies fit the needs of their patients and the staff they employ.

Sara Heath has covered news related to patient engagement and health equity since 2015.