Using an EHR for Care Management? It Will Cost You.

Repurposing an EHR for care management ultimately costs providers in various direct and indirect ways.

The False Economy of EHR-Based Care Management

When healthcare organizations consider implementing care management programs, many instinctively turn to their existing Electronic Health Record (EHR) systems. The reasoning seems sound: "We've already invested in this platform, so let's maximize its use." However, this approach often creates more problems than it solves, resulting in significant hidden costs.

The Fundamental Mismatch

EHRs were designed primarily for documentation, billing, and basic clinical data management—not for the dynamic, relationship-based work of care management. This fundamental mismatch manifests in several costly ways:

1. Workflow Inefficiencies

Care managers using EHRs typically report spending 60-70% of their time on documentation and administrative tasks, leaving only 30-40% for actual patient interaction. Purpose-built care management platforms flip this ratio, allowing care managers to spend the majority of their time on patient care.

A care manager at a mid-sized ACO shared: "With our EHR, I was spending 45 minutes documenting a 15-minute patient call. After switching to a dedicated care management platform, I document the same call in under 10 minutes."

2. Limited Patient Engagement Capabilities

Most EHRs lack robust patient engagement features essential for effective care management:

Limited or no automated outreach capabilities
Poor integration with remote monitoring devices
Minimal support for patient-reported outcomes
Clunky patient portal experiences

These limitations force organizations to either accept suboptimal engagement or purchase additional solutions, creating integration challenges and increasing costs.

3. Inadequate Analytics and Reporting

Care management success depends on identifying intervention opportunities and measuring outcomes. EHRs typically offer limited capabilities in:

Risk stratification and predictive analytics
Population health management
Care gap identification
Program ROI measurement

Without these insights, organizations struggle to demonstrate value and continuously improve their programs.

The Real Financial Impact

The true cost of using an EHR for care management extends far beyond the initial implementation:

Direct Costs

Staff Inefficiency: Care managers handling fewer patients due to administrative burden
Custom Development: Expensive customizations to make the EHR workable for care management
Additional Solutions: Supplementary tools to fill EHR gaps
Maintenance Fees: Ongoing costs for EHR customizations

Opportunity Costs

Missed Reimbursement: Inability to efficiently capture all billable care management activities
Staff Turnover: Higher burnout rates among care managers struggling with inefficient systems
Suboptimal Outcomes: Fewer successful interventions due to limited capabilities
Delayed Program Growth: Slower scaling of care management initiatives

Case Study: Community Health Network

Community Health Network initially attempted to run their Chronic Care Management program through their EHR. After 18 months, they had enrolled only 800 patients and were struggling with staff retention.

After implementing a purpose-built care management platform:

Enrollment increased to 3,200 patients within 12 months
Documentation time decreased by 62%
Staff satisfaction scores improved by 47%
Net revenue increased by $1.2M annually

The Right Tool for the Right Job

Healthcare organizations should recognize that EHRs and care management platforms serve different purposes:

EHRs excel at:

Clinical documentation
Order entry
Billing
Basic clinical decision support

Care management platforms excel at:

Patient engagement and outreach
Care plan management
Population health analytics
Workflow optimization for non-visit care

Making the Transition

Organizations considering a dedicated care management solution should:

Assess Current State: Measure time spent on documentation vs. patient care
Calculate True Costs: Include both direct and opportunity costs of the current approach
Evaluate Integration Options: Look for platforms that integrate with your EHR
Start Small: Begin with a focused pilot program
Measure Results: Track efficiency, engagement, and financial outcomes

Conclusion

While using an existing EHR for care management may seem cost-effective initially, the long-term financial and clinical implications often prove otherwise. By investing in purpose-built tools that integrate with EHRs, healthcare organizations can optimize both systems for their intended purposes, ultimately improving care quality while reducing total costs.

Remember: The most expensive tool is often the wrong tool used for the right job.