Posts Tagged ‘case managers’

Infographic: The Growing Demand for Case Management

September 23rd, 2015 by Melanie Matthews

The Growing Demand for Case ManagementThe increase in insured populations combined with a growing number of Medicare beneficiaries underscores the need for inpatient case management services, according to a new infographic by McBee Associates.

The infographic outlines the four key reasons why an adequately staffed case management department is important for hospitals.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

The Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Accessibility, Visibility Reasons to Embed Case Managers into Primary Care, Workplace

April 30th, 2015 by Cheryl Miller

When case managers are embedded into primary care workplaces, both patients and staff benefit, says Melanie Fox BSN, RN, director of embedded case management with Caldwell UNC Healthcare. Instead of delaying a patient’s request for care, staff workers are more likely to address it by going directly to the case manager on site. And some patients are more likely to directly ask the case manager, who they might previously have contacted telephonically.

Some people have embedded case managers but they might not be embedded in the practices. Our case managers are on site. They are available. They are visible. That makes it easy for the staff and the patients because sometimes they’ll think that patient may need something, but are unsure how to make that happen for that patient.

Then they see us or they remember we’re here. They’ll come to us and ask for help, trying to get that patient what they need, whether it be hospice services, VNA services, or just watching a patient’s blood pressure or hemoglobin A1C. If you’re there visible, it makes it so much easier for the staff and as well as the patients.

We have patients that drop by our offices just to see who we are because we’ve talked to them over the telephone. The visibility from us being in the office is great. We seem to be more accepted by the providers and the staff because of that, as well as the patients because they see us as part of the team. They see us working in the office. Sometimes, when we make a phone call to the home, they may accept it sometimes a little better because we’re calling from our clinics. When we mention where we are calling from and the name of the doctor we’re working with, then they’ll talk to us a little more willingly.

It makes that easier. It also helps to engage the patients in the office because they are here. A staff member will pull us into an office and let us know that one of the patients is here to talk to them. We have found that just being in the office is a great asset for the doctors as well as ourselves. It makes our jobs a little bit easier.

Source: Embedded Case Management in Primary Care and Workplace Clinics: Skill Sets, Stratification and Protocols

3 Goals of Hospital Home Visits: Reconciliation, Red Flags and Re-Education

April 14th, 2015 by Cheryl Miller

Hospital-initiated home visits conducted during post-discharge follow-up significantly curb avoidable admissions, readmissions and ER visits, according to findings from the Healthcare Intelligence Network’s 2013 Home Visits e-survey.

The hospital sector is almost twice as likely to conduct home visits than other sectors, and to focus on three key aspects of the discharge care plan: medication reconciliation, red flag recognition and patient/caregiver education.

Hospitals are much more likely to conduct home visits to conduct post-discharge follow-up than overall respondents, our survey found. Almost two-thirds of hospitals, which comprised 27 percent of the survey 155 respondents, visit patients at home following discharge, versus 43 percent overall. Hospital-initiated home visits are also half as likely to include a home assessment as visits by the overall surveyed population (16 percent of hospitals versus 37 percent of respondents overall).

A case manager most often conducts the home visit on behalf of the hospital; this sector is only one-fourth as likely to send a nurse practitioner on this visit (5 percent of hospitals versus 16 percent overall). The visits focus on key aspects of the discharge care plan: medication reconciliation, red flag recognition and patient/caregiver education.

That said, hospital case managers are more likely than their industry counterparts to offer palliative care during the visit (35 percent versus 29 percent overall), but only about half as likely to discuss nutritional status (29 percent versus 52 percent overall) or assess activities of daily living or ADL (24 percent versus 40 percent overall).

Chart reviews and EHRs comprise responding hospitals’ primary method of identifying patients in need of home visits. This sector is twice as likely to conduct home visits for 10 percent or less of its patient population (65 percent versus 37 percent overall).

Despite the frequency with which it conducts home visits, hospitals are twice as likely to report no return on investment from home visit programs (17 percent versus 9 percent overall), and are twice as challenged by home visit funding/reimbursement (61 percent versus 36 percent overall) and technology limitations (11 percent versus 6 percent overall).

Source: 2013 Healthcare Benchmarks: Home Visits

Home Visits

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions. This 40-page report analyzes the responses of 155 healthcare organizations to HIN’s inaugural industry survey on home visits.

Is a Population Health Management Approach Sustainable?

February 10th, 2015 by Cheryl Miller

Beyond the undeniable imprint of big data on the field of population health management (PHM) and the emergence of primary care on the PHM team, the most ringing endorsement of population health management derived from the Healthcare Intelligence Network’s second annual PHM survey is the resounding belief by almost all respondents (92 percent of hospital/health systems, and 100 percent of health plans) that a population health management approach is sustainable.

One respondent went so far as to say, “Nothing comes close [to population health management] in terms of managing systemic healthcare costs.”

Still, compared to conventional care management, PHM is still in its infancy, despite the plethora of analytics harnessing healthcare data for PHM consumption. Many respondents are careful to bear in mind the individual patient behind the electronic health record or health risk assessment, balancing the use of risk stratification tools like predictive modeling with a hands-on approach.

Underscoring this, a half-dozen respondents pointed to specially trained case managers, human communication, and interdisciplinary conversations as their most successful PHM tools, along with a host of behavior change techniques employed in telephonic and face-to-face interventions: motivational interviewing, intrinsic coaching and patient activation.

While these approaches are gaining ground in terms of reducing avoidable utilization and healthcare costs, the survey indicated that engagement of patients in population health management remains a significant challenge for almost a third of 2014 respondents (although it is less a barrier now than two years ago, when almost half of respondents struggled with patient engagement).

Perhaps with more primary care physicians on the front lines of PHM, reluctant patients will become less of an issue. As one respondent noted, “For PHM to work, it requires both physician and patient engagement for a selected population. Being all things for all people is not sustainable.”

Source: 2014 Healthcare Benchmarks: Population Health Management

2014 Healthcare Benchmarks: Population Health Management Now in its second edition, this 50-page resource analyzes the responses of healthcare organizations to HIN’s second comprehensive industry survey on PHM trends administered in June 2014. It delivers the latest metrics and measures on current and planned PHM initiatives, providing actionable data on the most effective PHM tools and workflows, risk identification strategies, tools to boost health plan member and consumer engagement, modalities for program delivery, and much, much more.

9 Hospital Discharge Communications Tactics to Curb Readmissions

January 27th, 2015 by Cheryl Miller

For heart failure patients making the transition from hospital to home, an effective discharge summary can mean the difference in whether the patient recovers quickly or returns to the hospital, according to two new studies from Yale School of Medicine researchers. To be effective, discharge summaries must have three key factors: they must be timely, be quickly forwarded to the outside physician, and contain detailed and useful information.

We asked the 116 respondents to the fourth annual Healthcare Intelligence Network’s (HIN) Reducing Hospital Readmissions Survey, conducted in December 2013, what hospital discharge communications tools they used to lower their readmissions rate. Following are their responses.

  • Follow-up with patient post-facility discharge by case managers embedded in our physician practices.
  • Improved communication between inpatient (hospital) care coordination and outpatient (medical group) services.
  • Follow-up appointments with the doctor and home care arrangements are made prior to discharge from the facility if appropriate. Discharge information with medications are sent to the doctor’s office by the facility doctor on discharge for availability on follow-up appointment.
  • Increased oversight of high-risk patients; increased communication among clinical teams and health providers.
  • We utilize a transitional care program to engage with patients while in facility and continue to follow with in-home visits on discharge to continue education and teach-back as well as monitor and oversee progress.
  • Post-acute touch (home health) within 24 hours of discharge; medication reconciliation, signs and symptoms education and scheduling primary care physician (PCP) office visit appointment.
  • All discharges are called by our nursing supervisor or other designee to determine their post-discharge status and ensure they keep their follow-up primary care appointment.
  • Reaching the patient within one to two days post-discharge. Assuring the patients have a follow-up appointment and transportation, understand discharge medications, red flag symptoms and who to call if necessary.
  • Follow-up in the home for 35 days post-transition to home.

Source: 2014 Healthcare Benchmarks: Reducing Hospital Readmissions

2014 Healthcare Benchmarks: Reducing Hospital Readmissions documents the latest key initiatives and partnerships to reduce readmissions by patients with these costly conditions and others by more than 100 healthcare organizations.

2 Essential Steps for Embedding Case Managers

April 24th, 2014 by Cheryl Miller

Selecting the right practice for embedded case managers, and then getting physicians to embrace the concept, are key to successfully embedding case managers, say two thought leaders, Irene Zolotorofe, RN, MS, MSN, administrative director of clinical operations at Bon Secours Health System, and Randall Krakauer, MD, national Medicare medical director for Aetna. Here, they discuss how to best implement these steps.

Question: How did you select practices for embedding of case managers, and what were the first steps in preparing the practice?

Response: (Irene Zolotorofe) They were chosen primarily at the recommendation of some of our operations directors; also, we began with the physicians who are absolutely willing to go ‘medical home,’ that are excited about this model of care. We like to go into a practice where they are motivated to do that type of transition with their patient population.

Physicians are the key; as a physician group expresses interest, we work with them first, since they are key to getting a whole team going. We work hand in hand with the physicians and then the practice managers, and then we bring the process down to the rest of the staff. It takes us about three months.

Question: What marketing strategy is employed to encourage the physician groups to collaborate and embrace the concept of embedding health plan case managers in their practices?

Response: (Dr. Randall Krakauer) What doesn’t always work well is to start with ‘I’m here to help you.’ It is a matter of meeting with your physicians and discussing some of your mutual goals and mutual interests. We focus on those aspects of the equation in which we have common interests: quality of care, doing a better job for our members, your patients. We focus on areas in which we have the opportunity to work together. We show them what we have accomplished in the areas of care management on our own. We can show them at this point, since we’re not new to the game now, some results that we have achieved with other physician partners. And we initiate a discussion on how we can support each other, how we can work together to meet our mutual goals and how we can both benefit from this process.

And with a little bit of time and effort in a great many cases, some great things can happen as a result of such discussions.

Excerpted from Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators.

3 CM Qualities That Engage Populations in Telephonic Case Management

February 12th, 2014 by Jessica Fornarotto

Beyond scripts and data, there are three qualities that a case manager should possess to successfully engage populations in telephonic case management, says Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA).

We have found that if case managers are more comfortable with a certain illness or population, they tend to engage members better. We are still trying to figure out the nuances within each population. People who have done more child/adolescent work engage parents better than substance abuse recovery individuals do. People that do a significant amount of substance abuse recovery do a better job with that population than with the adult mental health population. There is an X factor or a subdivision with this.

Second, case managers need to be extroverted people who do not mind making the outgoing phone calls. While we need scripts and data to drive our program, the people who make it most successful are the clinicians who are most comfortable engaging those individuals. However, they are the least comfortable with paperwork, which is why we make our paperwork as simple as possible. We want to be sure that they can point and click, and go straight through it. It is one flowing process for them.

Finally, management also supports engagement. It is important to talk to the staff about success stories and what happened that made them successful. They should use it as a learning opportunity for everyone, but also as a celebration opportunity. As long as we can keep case managers enthused about the program they are doing, that enthusiasm comes through in their voice when they are talking to individuals on the phone and it helps them go the extra mile. It helps them with the process of relating to members at the other end.

“At CBHA, we developed our telephonic case management program to find a way to support and improve the care of some of our most vulnerable members. We want to be good stewards of the monies that are given to us by our client companies to pay for their behavioral health claims,” said Jay Hale.

Excerpted from: Telephonic Case Management Protocols to Engage Vulnerable Populations

Healthcare Business Year in Review: A Look Back at 2013’s Top Stories

January 9th, 2014 by Cheryl Miller

From an early surge in Medicare accountable care collaborations to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 was nothing short of unpredictable.

But in this issue, as in “Best of” issues past, we bring you the stories that resonated most with you. Your top story was one that ran nearly a year ago: Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients. This initiative from Cigna monitored telephonic outreach by health plan case managers within 24 hours of hospital discharge, finding that they reduced future readmissions by 22 percent. Resulting in more physician visits and prescription drug fills, the timing and prioritizing of the calls was critical to its success.

Case managers’ roles in long term care also spiked your interest in our featured white paper: Case Management in 2013: Achieving Results with Cardiovascular Disease; Long-Term Care Next Frontier for Embedded Case Managers. As care coordination by healthcare case managers continues to drive clinical and financial outcomes in population health management, expect to see lots more case managers — not just coordinating care telephonically like Cigna, but co-located in nursing home, long-term care (LTC) and assisted living settings.

Other top stories included CMS’ announcement that Medicare beneficiaries saw significant out-of-pocket savings due to the ACA, including provisions to close the prescription-drug “donut hole” that saved more than 7.1 million seniors and people with disabilities $8.3 billion on their prescription drugs since it took effect.

How the ACO model figures in most hospitals’ futures also topped your reading list, as did a story on how 24 states and the District of Columbia chose a benchmark health insurance plan that met the ACA’s essential health benefit requirement, which is scheduled to begin next month, January 2014. Researchers found that 19 of the states that selected plans chose existing small-group plans, employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans.

An infographic on 2013’s Most Significant Healthcare Issues, and our podcast on Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements also attracted the most views.

We will continue to provide you with the kind of up-to-the-minute coverage you need to stay informed.

And as with issues past, we send our best wishes to all of you for a happy, healthy, prosperous and peaceful new year.

Embedding Case Managers as Ambassadors of Advanced Primary Care

October 18th, 2013 by Cheryl Miller

Embedded case managers are carefully being groomed as ambassadors for the evolving patient-centered healthcare landscape, a perspective that seeks to achieve the Triple Aim objectives of better care, experience and cost.

And while challenges to employing embedded case managers persist, including staff buy-in and communication, reimbursement is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), a participant in CMS Innovation Center’s Comprehensive Primary Care (CPC) initiative. TIPA helps physician practices in New York’s Hudson Valley to improve population health and care for their sickest patients with the use of embedded RN case managers. Watson shared TIPA’s deployment strategy during an October 9, 2013 webinar, Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community.

One of the first steps is finding case managers with the right combination of education, experience and attitude, says Watson. The immediate past chair of the Commission for Case Manager Certification, she has served as a commissioner since 2007. They must meet strict requirements, including having either the Commission for Case Management Certification (CCMC) or RN board-certified designation from the American Nurses Credentialing Center (ANCC). Both of those organizations have mandatory continuing education requirements around case management, important because case managers must be current clinically in order to meet the ever changing field of disease management, and be effective in dealing with either the chronically ill, or those with complex comorbidities.

Embedded case managers must also be ready to address such issues as redesigning workflows and conducting risk stratifications. These issues tend to be obstacles to effective management of patient panels, so case managers with that skill set are highly valued, she explained.

Once deployed, the embedded case manager assumes various roles in physician practices, from supporting the CPC to meeting accountable care organization (ACO) and patient-centered medical home (PCMH) requirements. The Medicare ACO measures and specifications talk specifically about care coordination and patient safety activities, Watson says. Within Comprehensive Primary Care, there are requirements and milestones around managing their high-risk patients and active engagement and care coordination across medical neighborhoods.

Watson also shared effective ways to use electronic medical records (EMRs), patient registries, payor data and other tools within a practice to support the embedded case manager.

But one of the final frontiers might be physician buy-in, Watson says. One of the ways to get physicians on board is when initially implementing the case manager into the practice. Getting just one physician champion in the practice to help with the change is key to the overall success of embedding case managers.

Annette Watson talks more about embedding case managers in an open multi-payor community in this Healthcare Intelligence Network webinar.

4 Ways Aetna Identifies Cases for Compassionate Care Outreach

August 5th, 2013 by Jessica Fornarotto

People often think about an oncology diagnosis first when considering advanced illness care needs. However, Aetna’s Compassionate Care program benefits individuals across the advanced illness spectrum and across the disease spectrum — lots of patients with kidney disease, CHF, COPD and other diagnoses can and do participate, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare.

During HIN’s webinar, Advanced Illness Care Coordination: A Case Study on Aetna’s Compassionate Care Program, Dr. Agostini listed four ways Aetna identifies cases for the Compassionate Care program, specialized case management that provides additional holistic and patient-centered care and support not only to Aetna Medicare members with advanced illness but to their families and caregivers.

Case identification is important for the Compassionate Care Program; you need to identify who you’re going to help. We have four ways to do this:

First, we have a claims-based algorithm that helps to identify and predict members using diagnoses that we know about and other informational data to identify patients with early to mid-stage advanced illness. This way we can reach out to them and engage them early in the process.

Not everyone has an identifiable condition prior to end-of-life, so the algorithm is never 100 percent. But it gets us there to create a cohort of patients we know are really in need. For those without a predictive algorithm, most clinicians should be able to construct a list of diagnoses and diseases to identify a potentially eligible cohort who would benefit from services in advanced illness care.

The second way we identify members for the program is through the assessments and clinical judgments of Aetna case managers. We reach out to many members — nearly one in five on an annual basis — and through those conversations we identify patients at a certain stage in illness who could benefit from engaging with a nurse case manager for their advanced illness needs.

The third way is through direct referrals from physician offices. Sometimes we get direct calls, and sometimes we have an Aetna Medicare nurse embedded in that practice who works side by side with the provider group or healthcare system and generates direct referrals.

The last way we identify cases is via self-referrals; an Aetna patient may call about another issue. We identify through the questions they’re answering whether they could have a potential need for an advanced illness-related concern.

One important thing is that our program is not designed around any one particular diagnosis. Some patients have multiple comorbidities, particularly in the Medicare population. Managing the whole person is key.