by Webmaster
Published on Aug 22, 2016

Ignoring the changes that are raging through the hospital industry is not acceptable. Hospital leaders must create case management programs that are aligned with the marketplace challenges. Inertia is not an option. With change there is an opportunity to improve the quality and outcomes of care for thousands of patients by working together, coordinating care for selected patients, and controlling costs.


The transformation of healthcare is no longer a pundit's prediction...it's here.  The shape of the transformation is quickly becoming clear for hospitals and hospital case management programs alike.  There are new technologies and processes to be adopted to fundamentally transform the basics of the program beyond incremental approaches.  Here are strategies that every hospital can adopt::

1.  Change the DNA of the care managers role - Care management is at the heart of a comprehensive case management program.  While it only reflects one component of a compilation of services generally found under the case management umbrella, it is the most significant as the entire industry shifts from volume to value.  Care managers must reorient themselves as the patient's primary, pro-active advocate to minimize the patient's exposure to avoidable clinical or financial risk.  In terms of day to day workflow, it means that patients who may be at risk must be identified and a care manager assigned to work with that patient and the patient's care team to influence progression of care and to use whatever resources are available to avoid excessive, wasteful and potentially harmful medical interventions or care and services that may be contrary to the patient's or family's preferences.

2.  Engage the physician - Instilled through the medical eduational process, physicians bring biases to the table that affect their ability to embrace - or even accept - change.  Among these is a competitive, hierarchical and autonomy bias that makes doctors feel like they are losing control when changes are made around them and often without their input.  However, if the exec team invests in true leadership development to make the case for the need to change in view of new market dynamics and to stay competitive in the marketplace, and case management program directors invest in practical education targeted at helping the physician navigate the new rules and regulations, physicians might be more amenable to a working partnership with a care manager.  Care management will not be successful without fundamentally changing the way physicians view the world and that begins with changing how the care manager  interacts with the physician, the patient and the care team.  If the physician sees value in these interactions, the chances are good that the advocacy role of the care manager will be viewed more favorably.

3. Utilize New Efficiencies - Develop a centralized post acute resource center (PARC).  One of the major work activities that compromises the care manager's visibility to the patient, physician and care team  is finding and arranging post acute services. Once the care team agrees on a post acute plan,  refer the plan to the experts in the PARC for all the 'hunting, filing, phoning, and faxing' activities that accompanies every discharge plan.  By centralizing the PARC team and its activities, future expansion of the program can be implemented as care management across the continuum becomes a reality.  In addition, if the CoP discharge planning standards as proposed are approved, nurses will have to resume their discharge planning role for those patients who are not being followed by a care manager and having a PARC available for them will be essential to keep them present on the unit at their patients' bedside.