Q&A: Embedded Workplaces, Home Visits Emerging Trends for Case Managers

Thursday, March 28th, 2013
This post was written by Cheryl Miller

As the healthcare industry continues to evolve in the wake of ACA reforms, case managers are taking on more standardized collaborative approaches to care coordination and its changing delivery systems.

Prior to her presentation during a February webinar on The Role of Case Managers in Emerging Care Delivery Models, we talked with Teresa Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, president, Ascent Care Management, about emerging trends in case management, including embedding case managers at large employer work sites, and the proliferation of home visits.

HIN: What advice do you have for case managers going into embedded workplaces and what are some of the obstacles those already embedded have encountered?

(Teresa Treiger): One of the most important things to keep in mind is that you’re walking into someone else’s territory, where dynamics and relationships are already established. There’s a trust amongst the staff that’s already there.

As a case manager, you need to survey the landscape to figure out how people relate to each other, and then just use good business etiquette, for lack of a better way of expressing it. It doesn’t mean that you change your case management process. Absolutely not. We know case management. But how we relate to the people around us is probably the number one thing.

You will be faced with a situation, without a doubt, that has challenged other people. It could be a difficult patient or a patient that’s labeled as being difficult. And that is where you are going to prove your worth, by leveraging the skills that you have to find out what really is the issue or issues going on, and finding ways of addressing them. You might not be able to solve all of them. But you can address them in a professional way, helping that individual to resolve something, to get a service they haven’t been able to, maybe obtain some equipment or get a community resource hooked up with them. That’s when you start to develop your own currency of trust with the people that you work with, and that’s what’s going to get you firmly ensconced as a part of the team.

HIN: Will we see more case managers called upon to do home based care?

(Teresa Treiger): I think so, for a couple of different reasons. There are already community-based companies that do home care. And (case managers) may be part of or leading the team of lay care workers for these companies, (acting as) main points of contact to their individuals, at least when the client, or a family member has the resources to engage a company like this. These are often for-profit companies that will step in and provide a network of community-based individuals who come in and help for those who don’t qualify for other services.

There’s also the Visiting Nurse Associations (VNAs.) I’m not entirely sure what they’re going to be doing with case managers, but there is definitely an opportunity for them.

Accountable care organizations (ACOs) will also be using case managers that are assigned into a practice, or a group. It doesn’t matter where the patients of that group are, in the hospital, in the skilled nurse facility, at home. That case manager is part of that individual’s team. If the individual is at home, and hopefully most of them will be, they’re going to be helped there. It’s very resource intensive, because not only is the case manager not in the office, where other people may need him or her, there’s travel time, and the issues that go with that. And so while it sounds like a really great plan, the reality is there’s a cost involved, of both money and human resource.

The bottom line is that the Affordable Care Act (ACA) already highlighted community-based care. So the opportunities will be and continue to be out there for case managers to be more involved with their communities at a community level.

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