The Role of Case Managers in Emerging Care Delivery Models

With ACA reforms underway, the case manager is fast becoming a major player in the patient-centric, quality over volume healthcare mindset, taking on more standardized, collaborative approaches to care coordination and its changing delivery systems. But as crucial as case managers are to the evolving healthcare landscape, they also need to realize that they are, in many ways, the new kids on the block. Embedded case managers in particular need to understand that how they relate to their professional partners is one of the most important keys to their success, explains Teresa Treiger, president of Ascent Care Management. Here she shares her views on this and other aspects of the industry, including the opportunities for home-based care and how case managers can maximize the use of technology to manage patient care plans.

Teresa Treiger provided perspectives on the changing healthcare landscape for case management and care coordination during The Role of Case Managers in Emerging Care Delivery Models, a February 21, 2013 webinar, now available for replay.


Length: 13:06 minutes

Advanced Illness Care Coordination: A Case Study on Aetna’s Compassionate Care Program

Aetna’s Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less time in the hospital. Patient satisfaction with the program is high, he says, which reflects the strong bond between Aetna members and nurse case managers. In this interview, Dr. Agostini explains the key elements of the Compassionate Care program as well as some of the challenges the case managers may face in the management of advanced illness.

Dr. Joseph Agostini presented during Advanced Illness Care Coordination: A Case Study on Aetna’s Compassionate Care Program, a 45-minute webinar on June 13, 2012, now available for replay, during which he shared the key features of the Compassionate Care Program at Aetna, along with the impact the program has had on healthcare utilization and quality outcomes.


Length: 3:53 minutes

Recruiting, Training and Case Load Management Strategies for Embedded Case Managers

When looking for new hires for its embedded case management program, Bon Secours Health System looks for critical thinking skills and previous roles that are transferable, such as work with chronic disease patients, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours. Zolotorofe also describes the importance of matching personalities when placing a case manager in a physician practice, how to build a trusting relationship between an embedded case manager and the physician and Bon Secour’s embedded case manager training process.

Irene Zolotorofe presented during Recruiting, Training and Case Load Management Strategies for Embedded Case Managers, a 45-minute webinar on May 3, 2012, sharing the process that Bon Secours has established for recruiting, selecting and placing an embedded case manager in their practices, along with details on case load management, tools used by case managers, benchmarks for measuring effectiveness and much more.


Length: 6:27 minutes

Leveraging Case Management Tools and Technology to Improve Outcomes

With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator, describes how an early interest in computers helped to drive development of two Web-based tools supporting Arkansas BCBS case managers today, the potential for these tools to support other areas of the company, and how one tool from the centralized portal is helping to standardize transitions of care for Arkansas BCBS members.

Karen Black presented during Leveraging Case Management Tools and Technology to Improve Outcomes, a 45-minute webinar on April 11, 2012, during which Black shared how the Arkansas BCBS tools repository was developed, how it fits into the case manager’s workflow and the key features that are directly attributed to improvements in patient care delivery.


Length: 8:48 minutes

Telephonic Case Management: Protocols for Behavioral Healthcare Patients

Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there’s a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale’s organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member’s care continuum.

Hale presented during a March 7, 2012 webinar, Telephonic Case Management: Protocols for Behavioral Healthcare Patients, during which he shared the case management protocol developed by his organization, including using scripts and surveys to assess patients’ engagement in the treatment process and identify patients at-risk.


Length: 10:20 minutes

Demonstrating the Value of the Embedded Case Manager for the Medicare Population

When healthcare providers and health plan case managers join forces in the physician practice, the end result is “care completion,” explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the “completion factor” of care that is ordered and provides feedback on the impact of this care.

Dr. Krakauer presented during the November 30, 2011 webinar, Demonstrating the Value of the Embedded Case Manager for the Medicare Population, during which he will share the strategy supporting Aetna’s embedded case management initiative, along with results from the program relating to healthcare utilization and member satisfaction.


Length: 6:05 minutes

The Role of Embedded Case Managers in Clinical Transformation

Embedded case managers are the latest step in CDPHP’s clinical transformation, which began in 2008 with a transition to the patient-centered medical home model and continued with the introduction of new payment models in 2009 and 2010. Lisa Sasko, CDPHP director of clinical transformation, and Charlene Schlude, the organization’s director of case management, describes the embedded case manager’s role in a new era of healthcare, targeted patients and disease states and some of the operational and cultural issues surrounding the co-location of case managers in physician practices.

Ms. Sasko and Ms. Schlude shared the business case for embedded case managers as well as an inside look at the day-to-day interactions of embedded case managers with providers in practices during a September 20, 2011 webinar The Role of Embedded Case Managers in Clinical Transformation, sponsored by The Healthcare Intelligence Network.


Length: 5:32 minutes

Embedded Case Management in the Primary Care Practice: Program Design and Results

Workflow rehearsals of key practice protocols ensure that the entire care team — including the embedded case manager — is prepared in advance, notes Robert Fortini, vice president and chief clinical officer at Bon Secours Health System. Fortini describes two workflows “rehearsed” by Bon Secours care teams, details the embedded case manager’s contribution to medication compliance in the practice, and explains key steps that precede the case manager hiring process.

Robert Fortini will explain how Bon Secours has adapted the Geisinger Health System embedded case manager model to meet the needs of its own population during Embedded Case Management in the Primary Care Practice: Program Design and Results, a 45-minute webinar on August 10, 2011.


Length: 7:38 minutes

2011 Metrics in Healthcare Case Management

Has the practice of embedding case managers at the point of care grown since 2010? In this month’s healthcare performance benchmarks podcast, Healthcare Intelligence Network’s Melanie Matthews analyzes trends in contemporary case management and the evolving responsibilities of today’s case manager derived from HIN’s January 2011 survey results.

Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center and Jan Van der Mei, the regional director of Sutter Health Sacramento Sierra Regions care management programs, supplement this data with commentary on the case manager’s role in their organizations.

More actionable data on case management are contained in 2012 Healthcare Benchmarks: Case Management, our new edition now available.


Length: 4:52 minutes

Co-Locating Case Managers in the Care Continuum


Co-locating healthcare case managers in care settings can improve communication with patients as they move through the continuum of care, says Jan Van der Mei, regional director of continuum case management for Sutter Health Sacramento Sierra Region. Ms. Van der Mei describes the major issues that case managers face while helping patients navigate the Sutter system, as well as the key role of case managers in reducing hospital readmissions.

Ms. Van der Mei is one of five contributors to the “Guide to Patient-Centered Case Management,” a 110-page resource of best practices in identifying, stratifying and monitoring individuals for case management. It documents the returns generated by targeted case management interventions in place at Geisinger Health System and other organizations, and the Q&A chapter answers more than 50 questions on patient-centered case management.




Length: 5:27 minutes