Compliance with Triple Aim goals, participation in CMS pilots to advance value-based care, formation of multidisciplinary teams and avoidance of CMS hospital readmissions penalties are among the factors driving placement of case managers at care points, according to HIN's 2014 healthcare benchmarks survey on embedded case management.
Participation in the Medicare Physician Group Practice Demonstration, the Comprehensive Primary Care Initiative, and the Multi-Payer Advanced Primary Care Practice demonstration has prompted a number of the survey's 125 respondents to embed case managers in primary care practices, hospital admissions and discharge departments and emergency rooms, among other sites.
To help organizations make the case for embedded case management, here are nine more program drivers, in respondents' own words:
- "Face-to-face contact with complex patients and their family to build trust and relationships, working directly with providers and staff."
- "Five to 8 percent of patients account for 40 to 60 percent of costs. It is logical. Second, ED visits and discharges represent at-risk patients where interventions can make a difference. Third, focus needs to be placed on fostering better screening results. Effort to reduce utilization."
- "Pursuing medical home model and team-based care, along with continuum care coordination."
- "Integration work between medical and behavioral healthcare."
- "Employer, health system, and payor collaboration to provide population health management in a medical home-like model. Also working on reducing readmissions for high-cost, high-risk conditions such as heart failure, and hospital wanted to develop an ambulatory component to reduce readmissions and improve patients’ quality of life and satisfaction."
- "Increased care fragmentation related to transitions in care, challenges in utilization between military and civilian network access-to-care, increased need for complex care coordination, etc."
- "We felt we needed to ensure the case managers were considered a part of the patient-centered medical home (PCMH) team."
- "Research shows [case managers] embedded at the point of care caring for the whole person in all healthcare environments produces better outcomes."
- "As a rural hospital, it made sense to make the best use of resources."
2014 Healthcare Benchmarks: Embedded Case Management provides actionable data from 125 healthcare organizations leveraging embedded or co-located case management to improve healthcare quality, outcomes and spend—including those applying a hybrid embedded case management approach.