2 Essential Steps for Embedding Case Managers

Thursday, April 24th, 2014
This post was written 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.

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