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.
The 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.
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. 
