| The case manager's early identification, stratification and care coordination of high-risk patients reduces hospitalizations and emergency room visits of the elderly and chronically ill, improves medication adherence and closes care gaps that trigger or exacerbate health conditions.
Today's healthcare case manager has moved beyond the health plan office, working alongside the primary care physician, the hospital discharge planner and the nursing home staff in a substantial care management role.
News and Trends in Healthcare Case Management
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.
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Recent Audio Interviews on Case Management
Karen Black: Leveraging Case Management Tools and Technology to Improve Outcomes
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Jay Hale: Telephonic Case Management: Protocols for Behavioral Healthcare Patients
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Dr. Randall Krakauer: Demonstrating the Value of the Embedded Case Manager for the Medicare Population
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Melanie Matthews: 2011 metrics in healthcare case management
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Jan Van der Mei: Co-locating case managers in the care continuum
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Rebecca Ramsay: Identifying, monitoring and managing target populations for case management
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Toni Cesta: Embedding a case manager in the emergency department
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Dr. Sam Toney: Applying integrated case management to Medicaid's high-cost, high-need members
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Diane Littlewood: The benefits of co-located case managers
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Mary Cooley: Priority Health's four-point strategy uses case managers to help reduce readmissions
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Aetna: The key role of case managers and advanced practice nurses in Aetna's Transitional Care pilot
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Geisinger Health Plan: Case managers backbone of GHP's efforts to improve care delivery
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Question: How do you build physican buy-in for the embedded case manager?
This week's expert is Diane Littlewood, Diane Littlewood, RN, BSN, CDE, regional manager of case management for health services at Geisinger Health Plan.
Question: How do you build physician buy-in for the embedded case manager?
Response: (Diane Littlewood) That can be a challenge. When we first started to roll out the models, this was about primary care redesign. The providers were struggling. Now they have fewer PCPs, and with all of the scheduling and mounds of paperwork, when they heard of something else coming t othem, they saw it as something more to do. The buy-in comes when the physician and the team actually start to see the value of th ecase manager - that ther are fewr phone calls coming to the frong because they are going toa direct access line, that complex phone calls are headed off to the case manager. The phsuciian sees the value of the CM. It may be that one case that the CM works with where there is a good outcome, or th ephsyician sees it as a time saving effort on his part. That's where the win win thing starts.
For more information on building physician buy-in for the embedded case manager, please visit: Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System
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Comprehensive Case Management Resources
Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination is a primer on embedded case management, from the selection and training of the case manager to preparation of practices for the case manager's arrival to a description of more than 15 tools, protocols and workflows in use in this retooled care delivery model.
Case Management Metrics: Charting Care Coordination Across the Continuum dives deep into several years of market research to identify case managers' influence and contributions in 10 key areas, including medication adherence, reducing avoidable ER visits, care transition management and more.
In the Case Management Answer Book Vol. I: FAQs on Risk Reduction, Care Coordination and Co-Location, industry thought leaders provide answers to more than 50 questions on the practicalities of case management, from required skill sets for newly hired case managers to engaging non-compliant patients to supporting a case manager embedded in a hospital ER.
2011 Benchmarks in Healthcare Case Management provides actionable information from 201 healthcare organizations on the prominence, placement and responsibilities of case managers as well as case management-driven results in healthcare utilization, cost and compliance.
Best Practices in Contemporary Case Management examines three separate case management initiatives as well as the impact of these programs on health outcomes, care delivery and resource utilization. It provides the details on case management programs being utilized at Sutter Health Sacramento Sierra Region, CareOregon and Lutheran Medical Center.
The Medical Home Case Manager: Profiting from Patient-Centered Care Coordination provides an inside look at the selection, training, skill set, processes and benefits of the Geisinger Health Plan case managers embedded within the payor's medical home practices.
Click here for additional healthcare case management resources
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