Posts Tagged ‘Embedded Case Management’

HINfographic: Case Management Trends: Face-to-Face Patient Encounters Edge Out Telephonic

September 6th, 2017 by Melanie Matthews

As integrated care management takes hold, patients are much more likely to interact with a case manager at their healthcare provider’s office today than they were four years ago, say respondents to the 2017 Case Management Survey by the Healthcare Intelligence Network. The embedding or colocating of case managers within points of care rose from 54 percent in 2013 to 66 percent this year, the survey found.

A new infographic by HIN examines the top case manager-patient interactions, case management monthly caseloads, details on return on investment for case management programs and more case management trends.

At the point of care or behind the scenes, care coordination by healthcare case managers helps to elevate clinical, quality and financial outcomes in population health management and chronic care, the all-important hallmarks of value-based care.

2017 Healthcare Benchmarks: Case Management provides actionable information from 78 healthcare organizations on the role of case management in the healthcare continuum, from targeted populations and conditions to the advantages and challenges of embedded case management to CM hiring and evaluation standards. Assessment of case management ROI and impact on key care components are also provided.

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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

7 Characteristics of a Successful Case Manager

March 3rd, 2015 by Cheryl Miller

What qualities are needed for a successful case manager? A background in community nursing helps, because the case manager can better place themselves in the patient’s shoes, having worked with others from the same background, says Melanie Fox, director of the Caldwell Physician Network Embedded Case Management program at Caldwell UNC Health Care. Prior experience in home healthcare is also beneficial for case managers, as is having helped patients through major illnesses, and then transitioned them back to work or home.

I want to talk about the qualities of a successful case manager. You want to have an independent thinker because you’re going to be doing a lot on your own. You’re in a practice by yourself. It’s the way we’re set up, but of course, we call each other if we have a question.

You want self-motivation for the same reasons, because you want somebody that is going to be motivated to help the patients and be able to think outside the box.

You need a strong skill set. I’ve found that a good home health background or experience in community nursing helps the case manager determine what a patient might need, because you’ve seen that in the community.

We have several home health nurses at work for us. We have a hospice nurse that works for us and a nurse that worked with insurance claims and worker’s comp. They all have some background where they’ve helped people get through an illness and transition either back to work or get back to where they were before their illness.

Of course, you want a confident nurse, and you need somebody that has the great passion for helping people and is strong willed. You want to take care of the patients, so you’re not popular all the time with the providers. We’re really an advocate for our patients. We’re not always telling them what they want to hear.

If providers don’t have room on their schedule, sometimes we’re really begging for them to see a patient. You have to have good communication skills, be determined to take care of the patients because that is our goal as they transition back to their home or from the facilities. As you know, the personalities are strong in our field of nursing. With the providers, we are in a position sometimes to be a little forceful.

Source: Embedded Case Management in Primary Care and Work Sites: Referral, Stratification and Protocols (Webinar available for replay)

Embedded Case Management in Primary Care and Work Sites: Referral, Stratification and Protocols presents Melanie Fox, director of the Caldwell Physician Network Embedded Case Management program at Caldwell UNC Health Care, as she shares how embedded case managers in both primary care practices and work sites are improving the quality of care and reducing healthcare costs by increasing preventive care measures at the work sites and improving care gaps for patients managed by the primary care practice.

Healthcare Payor Strategies for Co-Located Case Management

January 29th, 2015 by Cheryl Miller

How to best strategize the co-location of case managers at points of care? The key is to understand the population you’re serving, be very targeted, and direct your services appropriately, says Dorothy Moller, managing director in the government healthcare solutions business unit of Navigant Healthcare.

Question: New market data on embedded case management found that two-thirds of respondents have co-located case managers at points of care, including primary care practices, hospital ERs and patients’ homes. What are some payor strategies for matching case managers with providers, and how do health plans benefit from co-location?

Response: (Dorothy Moller) I must acknowledge the safety net payors, who have been co-locating case managers for a number of years — in particular in hospital ERs. Very often the case managers you co-locate are not healthcare case managers, but behavioral health or social services case managers.

In terms of strategies for co-location, it depends on the population you’re serving and what you’re trying to accomplish with that population. There are a number of places where you can co-locate case managers — not so much case managers as case or care coordination services. Very often in large multi-specialty or primary care practice settings such as federally qualified health centers (FQHCs), community clinics, or multi-specialty clinics, case managers are sometimes nurses, sometimes social workers, sometimes physician assistants performing various functions. They may link members with specific services that are non-health related or coordinate care.

The key is to understand the population you’re serving and to make sure you include case management and care coordination services appropriate for that population. If you have a very acute population with high risks or readmission or other health complications, clearly you’re going to have a different kind of co-located service and you’re going to place them in a different location than you would otherwise. If you’re trying to encourage more effective access of services, use of preventive services, use of nurse call lines, and so on, you might place those services in a primary care practice. Those are going to be very different.

Embedded case managers could even be community health workers. In fact, I’ve worked with payors in the Southwest using community health workers in that role. They are sometimes co-located within the practice but then go into the community and deliver education services there as well, sometimes in collaboration with medical and education specialists.

It depends on the population you’re serving, the types of services you want to encourage or direct members to, and the most efficient staffing model for those services. Ultimately, you must remember you’re trying to develop a better staffing pyramid within the practice so that physicians do the most complex work — where a physician’s skills and capabilities are most needed. Nurses and other staff deliver care and services appropriate for their skills, education and capabilities. Be very targeted, understand your population, and direct the services appropriately.

healthcare trends
Dorothy Moller, MBA, is a managing director in the Government Healthcare Solutions business unit of Navigant Healthcare. She has nearly 30 years of experience specializing on a wide range of strategic issues from business intelligence and competitive analysis, to market, business and product strategy and design, business and product innovation, and business and operations turnaround and repositioning.

Source: Healthcare Trends & Forecasts in 2015: Performance Expectations for the Healthcare Industry

12 Core Competencies for the Hybrid Embedded RN Care Manager

December 30th, 2014 by Cheryl Miller

Core competencies for a registered nurse (RN) are different than those for an RN care manager, says Mary M. Morin, RN, NEA-BC, RN-BC, vice president, nurse executive with Sentara Medical Group. When Sentara officially converted to a hybrid embedded case management model, RN care managers’ job descriptions had to be rewritten; to be successful in this new model, they didn’t necessarily have to have care management experience; instead, having a strong clinical background and experience doing patient assessments were more important.

To get RN care management away from the embedded telephonic model, we had to rewrite the job descriptions, and if you’re going to rewrite job descriptions, have a new position. This is different work.

We found out people will hear it, but until they go through it, until they feel it, they’re all for it until it actually happens. If I were to do this again, I would make everybody reapply for their job because this requires a certain type of individual. These people need to be able to engage patients for a long-term relationship. They have to know how to work with hospital-based caregivers, home health, life care and not just within our own healthcare system.

We established core competencies. Core competencies for an RN care manager are different than those for an RN. We have an ambulatory-based RN. We were looking for people that didn’t necessarily have previous care management experience, but who had experience doing patient assessments. They also had to have a strong clinical background.

Following are 10 more core competencies for the hybrid embedded RN care manager:

  • Job descriptions: BSN requirement
  • Maintain patient lists by populations
  • Accept assignments
  • Meet expectations
  • Send patient letter from primary care physician (PCP)
  • Engage patients
  • Send contact letter, brochure
  • Standardize work flow
  • Use SMG, Optima (Health Plan), and clinically integrated network (CIN) electronic medical record (EMR)
  • Hold meetings with home health and inpatient care coordinators
  • Complete education/training
  • Achieve specialty certification

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

11 Statistics About Embedded Case Managers

December 16th, 2014 by Cheryl Miller

CMS readmissions penalties and accountable care organization (ACO) cost savings were among circumstances driving some organizations to embed case managers, according to the Healthcare Intelligence Network’s (HIN) inaugural survey on Embedded Case Management.

The majority of the survey’s 125 respondents (68 percent) have embedded programs in place to meet the expanding demand for case management services across the healthcare continuum, with the intent of improving care and quality outcomes.

Sites for embedding or co-locating of case managers ranged from primary care practices (PCP) to the hospital discharge area.

Following are eight more statistics from the 2014 Embedded Case Management survey:

  • „„9 percent of respondents that don’t have such programs intend to implement them within the next 12 months.
  • The average monthly case load of an embedded case manager is 1 to 49, according to 34 percent of respondents. Slightly less than one third (32 percent) of respondents cite case loads of between 50 and 99 patients a month.
  • „„The majority of respondents (77 percent) prefer that embedded case managers be registered nurses; 55 percent prefer that they have a bachelor’s degree.
  • „„In addition to case management assessments (75 percent), provider referrals were a key factor in stratifying individuals for embedded case management, according to 52 percent of respondents.
  • „„In addition to the PCP and hospital locations, some respondents embed their case managers in skilled nursing facilities (SNF), sub-acute facilities, and oncologists’ practices.
  • Seven percent of survey respondents report program ROI between 2:1 and 3:1, and 3:1 and 4:1.
  • „„Patient satisfaction is among the greatest successes of embedded case management programs.
  • The biggest challenge of embedding case managers is maintaining a care management focus and communication, according to 22 percent of respondents.

Source: 2014 Healthcare Benchmarks: Embedded Case Management

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 who apply a hybrid embedded case management approach. This report also shares highlights from embedded case management initiatives at Caldwell UNC Health Care, where case managers are embedded with primary care and employer sites; and Sentara Medical Group, whose highly successful hybrid approach to co-located case management utilizes case managers during home visits, in the hospital, in the primary care provider office, on the phone or via online virtual sessions.

Sentara Home Visits for High-Risk ‘VIPs’ Drive Hybrid Case Management Outcomes

November 13th, 2014 by Cheryl Miller

When the Sentara Medical Group evolved to a hybrid embedded case management model in 2012, case managers spent time in the practice, but also managed care through other touch points, including home visits, explains Mary M. Morin, RN, NEA-BC, RN-BC, vice president, nurse executive with Sentara Medical Group. How to identify high-risk patients for case management, and home visits in particular? Here, Ms. Morin addresses that question posed by The Healthcare Intelligence Network during a recent webinar.

Question: How does Sentara identify high-risk patients for case management in general and for home visits in particular? Do all patients in the case management program receive home visits?

Response: (Mary M. Morin) This program started as a pilot in 2012. It was targeted at patients that we called very important patients — high-cost, high-utilizers, the top of the pyramid. There are about 2,300 patients within 11 of our primary care sites. We kept it small, with five RN care managers. That population included all payors, most importantly our health plan patients. Because of our health plan, we were able to really study whether RN care management had an impact on the total cost of care — not unlike other organizations, if you can find a cost savings and justify the expense of having RN care managers, it makes the case much more solid moving forward with formalizing the program.

We sorted those patients by high-risk, high-cost or high-cost, high-utilizers because of chronic diseases. We looked at patient with congestive heart failure (CHF), chronic obstructive pulmonary disorder (COPD), asthma, renal failure and diabetes. We excluded patients that had any traumatic event like a car accident or something that led to high-cost, or they had cancer or they were a transplant patient.

The purpose was to engage that population. It is voluntary. We studied that population for three years. It allowed us to measure our outcomes over time because we weren’t sure if there was seasonality to the patients with chronic disease: did they just not use services because of seasonal issues or because it’s a cycle issue within the chronic disease phase? After three years of data, we determined there is definitely a difference in the outcomes of this patient population and their utilization.

Home visits was one of the big differences in the model. The main reason to do home visits is not to do patient care, but to do an assessment of the patient’s environment. A lot of times, patients don’t share with us their actual living situation. They tell you that they’re walking, and then you find out they walk within a five-foot radius. The real emphasis for home visits was to get in and meet the patient in their environment.

We found that RN care managers in the home facilitated advance care planning. That is best done in the patient’s home with a family member present, not in the doctor’s office or waiting until the patient is admitted to the hospital. We found that patients appreciated the visits. The RN care managers who went in really cleaned up the medications. Patients will hold on to medications.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

6 Ways to Overcome Pushback to Embedded Case Management

September 11th, 2014 by Cheryl Miller

Change always incites pushback, and when Sentara Medical Group went from an embedded case management program to a hybrid approach, patient and provider pushback prevailed, recalls Mary M. Morin, RN, NEA-BC, RN-BC, nurse executive with Sentara Medical Group. Among the six ways Sentara overcame resistance was to establish and maintain patient-centered relationships, by conducting comprehensive initial and ongoing assessments with patients, and developing plans of care and coaching education for both patients and their caregivers.

  • We maintained patient lists by populations within our electronic platforms. We came up with a standardized screen or view for all care managers. There was a lot of pushback against standardization but the key is standardizing the workflows. Should someone go out on family and medical leave, you can transfer your patient list. It all looks the same.
  • They were given and are still given assignments. We set expectations, which is critical. We send patient letters from the primary care physician (PCP) on behalf of your primary care provider that state we have this resource to help you should you be admitted to the hospital. We’re very focused on engaging patients. We have a brochure, and each care manager has a bio form that talks about their background.
  • We built workflow within the practices, within care management and within our electronic platform. We had issues: Optima, our health plan, is on a different EMR, as are the practices within our clinically integrated network. Unfortunately, the ambulatory-based care managers, the medical group care managers have to move between these two other platforms as well as our platform.
  • We held many meetings with home health and in-patient care coordination. Putting a face to a name is very helpful, as is lots of education and training. We had to do the electronic medical record (EMR) training. We discussed how to engage and motivate patients. What’s motivational interviewing? We have a requirement that within two years case managers are required to have their specialty certification.
  • We defined the care manager’s role. The main piece is to establish and maintain patient-centered relationships. They conduct comprehensive initial assessments and ongoing assessments, identify ongoing needs of the patients and possibly their caregiver, developing care plans and then providing coaching support to the patient, caregivers, and family members.
  • We managed resources such as transportation. We contract with the taxi service for our few patients that don’t drive but need to get to their appointments or to keep them out of the EDs in the hospitals. They manage transitions of care. They conduct advanced care planning.

value-based reimbursement
Mary M. Morin, RN, NEA-BC, RN-BC, is a nurse executive with Sentara Medical Group, where she is responsible and accountable for non-physician clinical practice within the Sentara Medical Group (160 clinics/practices) to ensure integration and alignment with Sentara Healthcare, regulatory compliance, standardization of nursing practice/care, and patient safety.

Source: Hybrid Embedded Case Management: New Model for Cross-Continuum Care Coordination

Evolution of a Hybrid Embedded Case Management Program

August 8th, 2014 by Cheryl Miller

When a typical embedded and telephonic case management program didn’t yield desired results, namely, coordination of quality care for their high-cost, high utilizers with complex, chronic diseases, Sentara Healthcare System took steps to correct it.

Step one: Reevaluate the current program.

“When we really studied what they (RN Care managers) were doing, only about 25 percent of their time was spent doing care management. What happened was that they wound up becoming basically glorified office nurses. They were working on other projects from either the physicians or the practice manager,” says Mary M. Morin, RN, NEA-BC, RN-BC, nurse executive with Sentara Medical Group (SMG), which is part of Sentara Healthcare System, during A Hybrid Embedded Case Management Model: Sentara Medical Group’s Approach, a recent 45-minute webinar sponsored by the Healthcare Intelligence Network.

Step two: Redefine the RN nurse care coordinators’ job descriptions.

“We were focused on reducing the total cost of care…and improving patient satisfaction. We also measured quality of life. We were looking to see if engagement with an RN care manager improved the patient’s perception of their quality of life,” Morin says. To achieve this, SMG looked for RN care coordinators who could “engage patients for the long haul, know how to work with hospital-based caregivers, home health, and life care not just within their own healthcare system.”

Core competencies were also established. “RN care managers are different than RNs. We were looking for people that didn’t necessarily have previous care management experience, but who had experience doing patient assessments. They had to have a strong clinical background,” Morin says.

Step three: Rebrand the model as a hybrid program.

The ideal was to establish and maintain patient-centered relationships, Morin continues. The RN care coordinators needed to conduct comprehensive initial assessments with the patient as well as ongoing assessments, so they could identify ongoing needs of the patients and possibly their caregiver, develop care plans and then provide coaching education. They also needed to provide support to both the patient and their caregivers and family members.

Step four: Reap positive rewards.

Through 2013, SMG was able to do the following:

  • Reduce ED visits by 17 percent;
  • Reduce all cause inpatient admissions by 48 percent;
  • Reduce all cause readmissions by 21 percent;
  • Improve seven-day follow-up rates by nearly double. Patients followed by a care manager had a 98 percent seven-day follow-up rate within the medical group; the average rate was 49.5;
  • Reduce total cost of care by 17 percent.

Psychological and functional health of patients was also improved, Morin says. Assessments pre-and post-engagement with care managers showed a 48 percent improvement in the first stages of depression, and a 6 percent improvement of physical health. And patient satisfaction also increased.

It all comes down to increased attention from the care manager, Morin says. One example is intense transition follow-ups, so that within 48 hours of discharge, the patient is seen or called, and given a clinical assessment. And prior to discharge? “We implemented a first call strategy. When the patient thinks of the emergency department (ED), we want them calling their care manager first.”

Listen to an interview with Mary Morin here.

Transferring Telephonic Skills to Face-to-Face, Embedded Case Management

May 1st, 2014 by Cheryl Miller

Because many case managers come from telephonic backgrounds, embedding them in physician practices—an essentially new role—requires the right mix of qualifications and characteristics to handle face-to-face interactions, says Annette Watson, senior vice president of community transformation for Taconic Professional Resources. Case managers that are change agents, who are enthusiastic and welcome collaboration and have registered nurse experience, are part of the mix of qualifications and qualities that have proved successful for this role.

Question: What qualities and qualifications does Taconic seek in its embedded case managers?

Response (Annette Watson): We’re looking for our case managers to be registered nurses in the State of New York with unrestricted licenses to practice. Part of that background is that nurses have a wide ranging education that makes them generally able to care for chronically and complexly ill patients. In the physician’s practice setting, that qualification is really what we look at as a baseline for entry into this field. We then, at Taconic, look for them to have a certification as a case manager prior to their coming to us. That would either be a certified case manager (CCM) designation, or a registered nurse (RN) with a case manager (CM) designation from the American Nurses Credentialing Center, or an RN CM.

Both of those represent an experientially based qualification. That means that we don’t have to teach them from the baseline what case management is. But what we’re doing is refining skills for this new setting.

We also look for experience relative to case management work in a setting that has them working in a collaborative environment with physicians and patients prior to getting there that would create a transferable skill set.

Many times case managers have been deployed in settings where they’re telephonically based or don’t have direct contact with either physicians in practice or with patients in a telephonic model. We find that that’s a transition from one setting to the other that doesn’t always work without a lot of ability to overcome obstacles and create an environment where face to face interactions go well. So those are just some of the things that we’re looking for in background.

Lastly, in terms of qualities, we’re really looking at what we call ‘the right stuff.’ A personality type where people are enthusiastic about the work, are positive about the type of new groundbreaking work that they’re going to be doing in these new settings, often which is they’re often new to a practice and new to a role, so they’re very much an ambassador of what case management is. Those kinds of personality traits that make them change agents and collaborative and enthusiastic in the setting are all part of that mix of the qualifications and qualities that we look for.

Excerpted from Advancing Primary Care with Embedded Case Management: Lessons from the Taconic IPA Pilot