Continually monitoring skills and training needs and evaluating the workflow changes — operational, technological and cultural — inherent in an embedded environment are two important, ongoing challenges when working with embedded case managers, says Annette Watson, RN-BC, CCM, MBA, senior vice president of community transformation for Taconic Professional Resources.
Question: How do you meet ongoing training needs of embedded case managers?
Response (Annette Watson): Continuously assessing whether they are maintaining their skills is part of our challenge as the employer. One thing we look for when we hire is whether they are already certified as case managers, via either the Commission for Case Manager Certification (CCM) or the RN board-certified designation from the American Nurses Credentialing Center (ANCC). Those have mandatory continuing education requirements for case management. We always look at whether they stay current clinically as well. The management of diseases changes rapidly, new drugs emerge, etc.
We are fortunate to work with practices to develop clinical education offerings they offer in the practice, as well as those we maintain and offer to the nurses. We make sure that we as the employer are continuously upgrading and offering them opportunities for continuing education and training. Through their work in the practice, we measure the satisfaction levels and ability to successfully manage those cases. This indicates whether they need additional training in a particular disease or clinical area.
Everyone has their own annual evaluation plan in our model where they identify an area they would like to learn more about. Whether that is a clinical disease like diabetes, respiratory diseases, or cardiology, or the need to obtain more CEUs, we use that as part of the ongoing training. It is pretty intense to keep that up, and it is part of our challenge as the employer to do that.
Question: What are common workflow changes needed in a practice with an embedded case manager?
Response (Annette Watson): Some common changes are the following: identifying where this person will work; how they will receive telephone calls; if they will have an extension; if they will have equipment to work on or a space when they need to meet with patients. Those are some very common work flows we need to address up front. Furthermore, we make sure that people know the person is in the practice once they are embedded. Then, we look at workflow in terms of changes in communication in the EHR; ability to send a referral to the case manager; ability to set up a visit with the case manager that is sometimes done without another provider visit.
All of those are common workflow changes we address when we go in. We consider how those are going to occur from an operational perspective, a technological perspective and a cultural perspective. Having people think, ‘Oh, I can refer that’ is a change from the way they practiced.
Advancing Primary Care with Embedded Case Management: Lessons from the Taconic IPA Pilot describes Taconic’s commitment to embedded case management as well as the motivation behind the new entity and the case management-related services Taconic Professional Resources makes available to more than 5,000 physicians in its open, multi-payor environment.