Posts Tagged ‘case manager’

Top New Year’s Resolution: Talking More to Increase Medication Adherence

January 8th, 2013 by Cheryl Miller

Can we talk?

That might be all that’s needed to improve medication adherence, according to a new study from the University of California, San Francisco, and the Kaiser Permanente Division of Research. It’s a novel idea, and a worthy new year’s resolution, given that email and social media have all but rendered the art of conversation obsolete.

Researchers found that patients who were taking medications to lower their blood sugar, blood pressure or cholesterol and rated their doctors as good communicators were more likely to be medication adherent. Communication didn’t have to be limited to medication; instead, patients’ adherence was improved if they felt their physician established a trusting relationship with them and prioritized the quality of their communication.

A simple conversation could also help reduce hospital readmissions by 22 percent, according to a new study from Cigna. Researchers found that telephonic outreach by health plan case managers within 24 hours of hospital discharge helped to reduce future readmissions. Critical to the intervention was the timing and prioritizing of the calls, and the risk severity of the patients. The patients in this particular study were suffering from gastrointestinal, heart, and lower respiratory problems, and hospitalized for three days or more. Researchers would like to conduct this intervention on other high-risk patients to see just how widespread this program could be.

Knee sufferers’ laments have also been heard, and a bundled payment program specific to the treatment of knee replacement surgery is now available through a collaboration between Florida Blue and Mayo Clinic.

The program is designed to offset the costs of this surgery, which is considered to be the most common joint replacement procedure in the United States, and is performed on more than 600,000 patients annually, according to the AHRQ. Similar to many surgical procedures, knee replacement involves many individual medical procedures and processes. When done separately, the costs add up quickly. This bundled program compresses the costs into one amount, including the costs of anesthesia services; injections or drugs administered during the surgical procedure, including antibiotics; radiology/imaging services, and discharge planning and nursing care; among other services.

We also provide an insightful conversation with HealthFitness’ Dr. Dennis Richling and Kelly Merriman on providing the right health coach at the right time to the right individual. The integrative heath coaching organization implements this by utilizing three different types of heath coaches trained to interact with a range of patients along the health continuum. We expand on this in an upcoming book.

And if you’d like to talk, please voice your opinion on the subject of medication adherence in our new survey, (link) Improving Medication Adherence in 2013. We’ll be examining this trend and others in this third annual survey, which starts today.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

37 Population Health Management Benchmarks

December 26th, 2012 by Patricia Donovan

Contemplating a comprehensive population health management (PHM) program in the new year? The following data from 2012 Healthcare Benchmarks: Population Health Management may help to shape your initiative. The report analyzes PHM trends for 102 companies, including program prevalence and components, professionals on the PHM team, incentives, challenges and ROI.

Of those 102 respondents, 62 identified their organization type. Of those, 23 percent were disease management/health coaches, 14 percent were health plans and hospital/ health systems, and 8 percent were employers.

Organizations were surveyed in September 2012.

• Organizations that have a PHM program in place: 58 percent

• Organizations that don’t have a PHM program in place but plan to launch one in the next 12 months: 36.4 percent

Areas covered by PHM program:
Health promotion and wellness 83.3 percent
Health risk assessment 68.8 percent
Care coordination/advocacy 60.4 percent
Disease management 75 percent
Case management 66.7 percent
Other 16.7 percent

Populations served by PHM program:
Commercial 85.4 percent
Medicare 47.9 percent
Medicaid 41.7 percent
Uninsured 22.9 percent
Other 14.6 percent

Health risk levels served by PHM program:
All 71.7 percent
Healthy 6.5 percent
Moderate risk 26.1 percent
Complex (5 or more conditions) 19.6 percent
Other 0 percent

Health professionals on the PHM team:
Primary care physician 59.6 percent
Specialist/other provider 36.2 percent
Nurse practitioner 40.4 percent
Case manager 63.8 percent
Registered dietician 34 percent
Health coach 55.3 percent
Pharmacist 31.9 percent
Social worker 34 percent
Other 23.4 percent

Primary method of determining intervention level:
Claims data 33.3 percent
Chart review 8.9 percent
Pharma data 0 percent
Health risk assessment 15.6 percent
Biometric screening 6.7 percent
Electronic health record 8.9 percent
Registry 6.7 percent
Self-report 8.9 percent
Physician referral 2.2 percent
Other 8.9 percent

Q&A: Florida Blue Applies PCMH Principle of Increased Access

October 24th, 2012 by Jessica Fornarotto

Providing six hours per week of after-hours coverage is a requirement of the Florida Blue patient-centered medical home (PCMH) so that members have complete access to their physicians no matter what time of day, says Barbara Haasis, R.N., CCRN, senior clinical lead of quality reward and recognition programs at Florida Blue.

During an interview prior to her presentation for a May 10, 2012 webinar on “The Patient-Centered Medical Home: Lessons from a Statewide Rollout”, Haasis discusses requirements for their PCMH pilot, the role of a nurse educator in the PCMH to disease management and future plans for embedding case managers in their practices.

HIN: Your organization is several months into a statewide rollout of a PCMH pilot with more than 1600 primary care providers participating. We realize it’s too early to discuss any hard outcomes, but one requirement for the practices that are participating in the pilot is the availability of at least six hours per week of after-hours coverage. Why did Florida Blue make that a requirement for participation in the medical home pilot?

(Barbara Haasis): Florida Blue chose to add that because we are following, by the letter, the principles of a PCMH, as described by organizations such as the American Academy of Family Physicians. And one of the principles is increased access. In today’s society, where almost everybody is a working adult, and our program is for commercial members under 65 only, we wanted to make sure that our members could see their physicians either before work, after work, or on the weekends, if it was not a medical emergency.

HIN: Are any Florida Blue case managers currently working inside participating practices, or are there any future plans to embed health plan case managers in the practices?

(Barbara Haasis): At this point, our case managers are still inside of Blue Cross Blue Shield. We have expedited the process of referring a patient to our case managers, and we are looking at doing a pilot with one of our vendors that works with chronic diseases, wellness education, etc. That is still in the discussion phase, though.

We’re planning to put together a small pilot of about four or five practices and to put a nurse in the office who is not a case manager but a practice coordinator. One of the roles of this nurse would be to identify patients to move into Blue Cross case management or one of our disease or wellness programs.

HIN: Could you describe the duties of the nurse educators in the medical home pilot, especially as they relate to patients with any of the pilot’s five focus health conditions, which are diabetes, COPD, coronary artery disease, asthma, and CHF?

(Barbara Haasis): Right now we have three nurse educators. They are each assigned to a specific practice so that they can establish a relationship with that practice. Part of the scorecards that we give to our physicians on a quarterly basis includes metrics that measure whether or not our diabetics have received their preventive screenings and their chronic disease management.

If a practice is having an issue with a specific disease entity, the nurses can offer them some suggestions on how they may be able to improve compliance. If there are issues with cost, we may be able to work on that with our case managers. The nurses have a relationship with the practice. Where the practice is having an issue with the patient, they can call their nurse educator and get assistance that way. They’re also aware of the external opportunities, such as the American Diabetes Association, that our practices can refer their patients to.

Case Managers Gratified by Daily Lessons from Care Coordination

July 18th, 2012 by Jackie Lyons

Helping patients and learning new concepts on a daily basis are at the very top of the list of satisfying aspects of case management, according to recent HIN case manager interviews.

“I truly feel humbled to have people allow us into their lives and share the details with us at such a stressful time. That is the best thing about being a nurse,” said Helen Schreiber, executive VP of S&H Medical Management Services, Inc.

Another gratifying aspect of case management is treating patients and families with respect and kindness, especially at the end of life, added Sonia Morrison, case manager at Salinas Valley Memorial Healthcare System (SVMHCS), nurse assessment consultant and educator for veterans at Visiting Angels of Santa Cruz.

“It is most satisfying when the client I am working with reaches full potential and returns to life with the tools to be successful,” said Barbara King, co-founder and president of NurseValue, Inc.

Helping clients return to work is also a key part of case management. “Ensuring a win-win opportunity for all parties is satisfying. When the injured worker obtains excellent, goal-directed care, they return to work in a more timely and effective manner. In this society, we need to work, and facilitating a successful return to work ensures a good ongoing quality of life for the worker,” said Linda Van Dillen, executive VP/partner of S&H Medical Management Services, Inc.

Case managers identified other gratifying elements of their career:

“The knowledge base, the liaison role that a case manager has in communicating with the patient, family, administration, payors and post-acute providers. Problem solving, it’s like a puzzle,” said Hillary Calderon, senior manager of Corporate Case Management for HCA.

Victoria Powell, founder and president of VP Medical Consulting, LLC, said she is always learning, whether it is about a disease or condition, a new treatment option or a new resource for information. “Meeting new patients from all walks of life and discovering what makes them special and unique is also satisfying to me,” she said.

Stacey B. Hodgman, district director of case management for Kindred Healthcare, said, “I learn something new every day of my practice. It is continually both challenging and rewarding, and there is never a day where I look at the clock and say, ‘It’s only 3:00?’ On the contrary, I look at the clock and say ‘It’s already 3:00?!’”

Meet Healthcare Case Manager Kerry Stutzman: It’s All About the Relationship

July 13th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

Kerry Stutzman, RN, MS, CCM, Care/Case Manager

HIN: Tell us a little about yourself and your credentials.

Kerry Stutzman: I have my CCM; I was among the very first group to take the first CCM exam and obtain the title. I am a member of Sigma Theta Tau International, the honor society of nursing. I have an A.S. degree in nursing, a B.S. in applied social work, a BSN and a master’s degree in nursing.

I am a fourth generation Arizonian. My folks were both teachers; my Dad was an English professor at Northern Arizona University (NAU) and my Mom taught in the public schools. I have a brother and sister. I grew up in a beautiful small town, Flagstaff, AZ. It’s not so small anymore but back in the 1960’s it was. I was admitted to the NAU nursing program right out of high school, which was a huge honor; there were only two or three of us in this situation. I was so fortunate to have had such great teachers there who influenced me so much. I had similar experiences at the University of Phoenix and at Arizona State University (ASU). I met my husband in Flagstaff; I bought his roommate’s car. We moved to Phoenix in 1979 and were married in 1981. I have worked a variety of jobs: Visiting Nurse Service, as a home care nurse, I was director of nursing for Olsten Home Health Care, I was a patient care coordinator, a discharge planning coordinator, a discharge program developer. I worked as a floor nurse in a variety of areas: recovery room, orthopedics, spinal cord/head injury/stroke, arthritis/rheumatology, mental health (pediatrics and adult), trauma, surgical, pre-op, renal, neurology, oncology, general surgical, and gynecology/obstetrics. I have worked in field case management for the last 21 years.

What was your first job out of college and how did you get into case management?

I first went to work at Good Samaritan Hospital in Phoenix, AZ. At that time, back in 1979, it was one of the largest hospitals in the Phoenix metro area. I went to work on R5, a head injury and stroke rehab floor.

My first job in case management was as an in-patient care coordinator with CIGNA. My next job was starting a new discharge planning program at Phoenix Children’s Hospital. This job honed my discharge planning, home care and case management skills further. From this job, I went to work for Intracorp, which, at the time, was a major player in the case management arena. We primarily handled workers’ compensation cases smattered with some auto liability, catastrophic cases and other case management cases. Since leaving Intracorp, I worked for two other case management companies before starting Health Care Consultants of Arizona in 2009.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

There wasn’t really one particular moment. Prior to working at Intracorp, I moved around from job to job every few years because I would get bored and need more of a challenge. I stayed at Intracorp for 13 years before moving on to another case management job. So, it was obvious that I enjoyed working in case management as it provided me with a variety of cases to work on that kept me challenged. I also loved working independently.

In brief, describe your organization.

I started Health Care Consultants of Arizona (HCCAZ) because the opportunity presented itself and I had wanted to start my own company for several years. I have a social work degree as well as a master’s in nursing with a specialty in mental health and I wanted an opportunity to more fully utilize all my skills. HCCAZ provides case management services in Phoenix and some of the surrounding cities such as Tucson, Prescott, Casa Grande, Florence and Apache Junction. We are an Arizona company, we are not national. We provide personal service and treat our clients and their families as we ourselves would want to be treated. If we can’t directly meet a client’s need, we will assist with locating a person or service that can. Everything is about the relationship. As the saying goes “People may not remember exactly what you did, or what you said, but they will always remember how you made them feel” – Dr. Thomas L. Garthwaite, Under Secretary for Health. We strive to make our clients feel well cared for.

What are two or three important concepts or rules that you follow in case management?

  • Treat others as you would like to be treated; the Golden Rule.
  • Always have the patient’s best interest at heart.
  • Take the time to really listen, you’d be surprised what you hear.

What is the single most successful thing that your organization is doing now?

Meeting the needs of the clients served.

Do you see a trend or path that you have to lock onto for 2012?

Do more with less. Be creative. Be flexible.

What is the most satisfying thing about being a case manager?

Working independently and all that that entails. In my case, working for myself means being able to spend more time with patients, working pro bono if needed, being selective on referral clientele, and having control over my work product.

Where did you grow up?

I moved around quite a bit but always within Arizona. I spent most of my childhood in Flagstaff, AZ.

What college did you attend?

I initially attended Northern Arizona University in Flagstaff for my associate in nursing degree and my B.S. in applied Social Work; I went to the University of Phoenix for my BSN; and ASU for my master’s degree.

Is there a moment from that time that stands out?


Are you married? Do you have children?

Yes, I am married and I have a 24-year-old son.

What is your favorite hobby and how did it develop in your life?

Working in the yard is my de-stressor. As far back as I can recall, I have always loved planting things and watching them grow. In sixth grade I converted the aquarium we used to house lizards and such into a mini garden to grow corn plants. My classmates and I were fascinated by watching the plants grow.

Is there a book you recently read or movie you saw that you would recommend?

The Sunflower: On the Possibilities and Limits of Forgiveness. At the Lemberg Concentration Camp in 1943, Simon Wiesenthal (author) is summoned to the bedside of the dying Nazi soldier Karl Seidl. The soldier tells him he is seeking “a Jew’s” (Wiesenthal’s) forgiveness for a crime that has haunted him (Seidl) his entire life. The man confesses to having destroyed, by fire and armaments, a house full of 300 Jews. He states that as the Jews tried to leap out of windows to escape the burning building, he gunned them down. After Seidl finishes his story, he asks Wiesenthal to forgive him. Weisenthal records his and other’s responses and poses the dilemma to the reader.

Any additional comments?

You have to be a bit of a loner in this work area because you do work alone, independently, so much of the time, especially if you work from your home as I have done for the last 20 plus years doing this. I referred a friend of mine while I was working at Intracorp. She and I had worked on an orthopedic floor several years prior. She quit after about a year because she did not like working alone most of the time, she preferred the camaraderie of working on a floor in a hospital. It is very important for this reason, that as a case manager you keep yourself involved by attending groups, networking, attending educational workshops and having friends in the business to meet for lunch and to talk care issues over with. Keep yourself immersed.

Click here to learn how you can be featured in one of our Case Manager Profiles.

RN Clinical Care Coordinators: Rocks in Granite State’s Newest Accountable Care Program

May 29th, 2012 by Patricia Donovan

In what is believed to be the largest accountable care program in New Hampshire, the Granite Health Network (GHN) and Cigna are launching a collaborative accountable care initiative to expand patient access to healthcare, improve care coordination, and chip away at escalating healthcare spend associated with high risk, high utilization patients.

To benefit from this collaboration are more than 23,000 individuals covered by a Cigna health plan who receive care from more than 900 healthcare professionals across GHN’s five independent charitable healthcare organizations. Patients who need help managing a chronic condition such as diabetes or heart disease will be among the first to reap the new program’s benefits.

The new accountable care initiative will receive solid support from a team of registered nurse clinical care coordinators who will be embedded in care sites, according to a Cigna press release:

Critical to the program’s benefits are registered nurses, employed by each of the five GHN healthcare organizations, who serve as clinical care coordinators and are integrated into the care delivery team to help patients with chronic conditions or other health challenges navigate their healthcare system. The care coordinators will enhance care by using patient-specific data provided by Cigna to identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators will contact these individuals to help them get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

The care coordinators will also help patients schedule appointments, provide health education and refer patients to Cigna’s clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management. This initiative is unique in using data and analytics at the health system level to focus healthcare professionals more fully on engaging patients to improve the coordination of their care as well as develop best practice clinical initiatives across the GHN member health systems.

Cigna will compensate GHN for medical and care coordination services it provides. Additionally, GHN organizations may be eligible for financial incentives if they meet specified clinical and financial targets, Cigna said.