Condition Management Framework: - Targeting and Segmentation: At the center of the framework is the "Targeting and Segmentation" capability. This capability focuses on profiling and stratifying consumers into segments; identifying the individuals within each segment that would benefit most from proactive intervention; and defining the most appropriate intervention(s) for each individual/segment. It also includes routing consumers to Condition Management programs and interventions.
- Reach and Engage: Accenture's framework emphasizes the need to address all of the relevant member and provider "touch points"—those that present opportunities to glean information as well as to potentially influence members and providers. This capability is focused on understanding the consumers' health goals and objectives, and facilitating access to appropriate care and high-value coaching services through other Care Management capabilities.
- Notification/In-patient Management: This capability is focused on shifting traditional Utilization Management functions from authorizing care to obtaining insights that health plans and providers can use to proactively manage in-patient episodes. Specifically, health plans and providers are able to use this information to drive pre-admission activities, manage patient expectations regarding length-of-stay, proactively ensure discharge planning and coordinate appropriate follow-up activities with other Care Management capabilities. It also enables health plans to "dial up" or "dial down" the extent to which processes such as pre-authorizations, continued stay reviews and retrospective reviews are applied.
- Condition Management: This capability includes three primary sub-capabilities: general symptom management (i.e., nurse advice/triage), chronic condition management and decision support for major medical events. It is focused on working closely with consumers that have been targeted, reached and engaged in order to: Influence their behavior (e.g., improving medication compliance, making informed decisions regarding care/treatment options for significant medical events. Enable greater self-care sufficiency—particularly around chronic conditions (e.g., coaching diabetics to make sure their physician performs regular foot and eye exams). Support members and care team members (e.g., physicians) with information, reminders and alerts.
- Wellness and Prevention: This capability is focused on providing a broader set of age/gender/lifestyle (e.g., smoking) wellness and prevention services. The key distinction between this capability within the Accenture framework and traditional wellness and prevention programs is that these services and interventions are tightly integrated with the Condition Management Capability. Additionally, the interventions are customized to individual member needs and integrated with individual coaching activities.
Consumer Centric Care Management
Accenture has developed comprehensive assets that provide customizable consumer-centric care management capabilities. These include: risk identification and stratification, call center scripting and contact management software for population management, next-generation utilization management and workflow management, and population management tools including biometric monitoring devices/solutions and other Web-based software. These assets also include a broad set of best practices, performance metrics, deliverables templates and business rules. Our assets include software and services assets from several key alliance partners, including Health Dialog, the premier provider of integrated condition management and consumer-facing decision support services. Accenture's medical management solutions can be delivered under a variety of business models, such as consulting services, value-based pricing, business process outsourcing services and application outsourcing services provision. Return to Overview |