Case Management Tips for Hospitals or Health Systems

Hospitals and healthcare providers are under increasing pressure to improve patient outcomes and satisfaction. Pressure may be driven by value-based reimbursement or from patients who are increasingly informed and deliberately pursuing treatment at hospitals or medical groups with a reputation for superior care and better outcomes.

Value-based care has emerged as a potential replacement for fee-for-service reimbursement, and it measures the quality of care a patient receives, rather than the quantity. Today, the Centers for Medicare and Medicaid Services consider value-based care a key to improving healthcare quality and curbing costs.

That means care managers and healthcare providers need an arsenal of strategies to enhance patient experiences, improve outcomes, and reduce avoidable readmissions.

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How case managers can bridge gap between patients, providers

In the business world, team building and collaboration increases a company’s flexibility, productivity, and employee retention. Many of the same benefits apply to healthcare settings, where collaboration between patients and providers can improve patient outcomes, boost patient and provider satisfaction, and enhance the overall performance of the health system.

Case managers strive to engage patients and providers in collaborative planning so that patients may achieve successful outcomes and health systems and providers receive appropriate recognition and reimbursement.

A major task for case managers in hospital or health plan settings is helping patients manage chronic illnesses. While the details may depend on the illness and the patient’s age, collaboration between service providers and patients is a fundamental component to effectively managing chronic disease.

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Case Management Strategies for Assessing, Engaging Patients

It’s no secret that many patients with chronic illness struggle to adhere to medical recommendations and treatment plans; the World Health Organization (WHO) has determined adherence to long-term therapy for chronic illnesses in developed countries is a meager 50 percent—and even lower in developing countries. What’s more, the WHO found, the impact of poor compliance is growing worldwide.

Poor compliance can lead to disease complications, avoidable exacerbations and frequent hospital admissions for patients, as well as increasing costs for health systems and the community. As families try to balance work and the responsibilities of being a caregiver, businesses lose highly productive and knowledgeable employees and patients face continued pain and suffering.

As a case manager, you play a central role in helping your patients or clients achieve better compliance and adherence to their care plans, which can lead to improved health, reduced hospitalizations, and stronger health systems.

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Managing Care From a Whole-Person Perspective

In order to reduce hospital admissions and readmissions, it’s important to address a client as a whole person and not a collection of chronic conditions. When multiple factors are a part of assessment and care planning, services go beyond just treating a patient’s symptoms or underlying illness.

An integrated whole-person approach recognizes many moving parts in a client’s life are fundamental to closing the gap between sickness and health. An evidence-based report in the U.K. commissioned by the King’s Fund and Nuffield Trust found “integration without care coordination cannot lead to integrated care.” In other words, effective care management is achieved only by taking into account the holistic needs of the client.

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The Link Between Collaborative Problem Solving and Care Planning

Working in a healthcare means you face complex challenges; chief among them is supporting a patient population suffering an increasing rate of chronic health conditions. With growing financial and regulatory constraints and rapidly evolving medical technology, healthcare organizations and providers are struggling to engage patients and find ways to address social determinants of health like poverty, food insecurity, and housing.

Today more than ever, case management and care coordination strives to incorporate medical treatment and interventions, social support, and an individual’s self-identified goals in a comprehensive care plan. Engaging in collaborative strategies between clients and the healthcare system improves healthcare planning, and ultimately outcomes. As healthcare shifts toward strategies focusing on needs and outcomes of specific populations, it is important to identify interventions most effectively yielding the best results.

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Why Cultural Awareness is Key in Care Management

Understanding a Client’s Culture can Improve Compliance, Reduce Healthcare Costs

Each person is a product of their culture and is also a culture of one. Culture is a set of beliefs handed down from generation to generation and is unique to a group of individuals. It affects how we see the world, how we process information, and how we communicate.

In healthcare, culture plays a significant role in how we understand directions, reduce medical errors, improve preventive care, and encourage compliance. Each of these factors impacts healthcare costs, and each is an important facet of good case management.

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By Jennifer Moore Ballentine

It’s National Case Management Week and, fittingly, we want to celebrate you—the case managers, care managers and care coordinators whose work is so critical to the health and well-being of our most vulnerable populations. We’re so grateful to you and the organizations that employ you.

Care managers are among the greatest champions of an emerging healthcare movement built around the patient—or, more accurately, the person. What does this person and family value most, what inspires them, and what challenges and barriers must be addressed so they can optimize their health and quality of life?

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The Importance of Health Literacy When Facing Chronic Illness

By Theresa E. Jenner, MSW, LICSW, CCM

Research and anecdotal experience frequently remind caregivers that low health literacy among patients can significantly impact outcomes and increase healthcare costs, especially in the context of a chronic illness. Yet to understand the impact of low health literacy, one must first understand the meaning of the term.

Federal statute defines “health literacy” as “the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.” In simpler terms, does a patient understand her illness, its treatment and its progression? Can a patient communicate with her care team when she has questions or concerns?

The National Health Council estimates that 133 million Americans are living with a chronic disease. These people have various levels of functioning in the community. They may be living alone, dependent on caregivers or residing in a long-term care facility.

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Good Training Needed for Case Managers

People with complex medical needs face myriad challenges when it comes to following the “do’s and don’ts” designed to help manage their chronic conditions and avoid painful exacerbations and costly hospitalizations. A growing body of evidence suggests there may be a better way.

Multiple studies show motivational interviewing (MI) is an effective tool for eliciting behavioral change across a wide spectrum of healthcare challenges—and that good training is needed to equip care managers and other professionals with the MI skills that can help patients resolve ambivalence and achieve their goals.

Empathy and compassion are cornerstones of MI, which utilizes a series of steps to guide patients through stages of readiness. In MI, patients do most of the talking, while providers engage in reflective listening and other techniques that helps patients identify what behaviors they want to change, and how they want to do it.

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It’s all About Relationships: How Care Managers Can Increase Patient Activation, Lower Healthcare Costs

Communication, trust and mutual respect are important in any relationship, and that’s certainly true in healthcare. Patients with complex needs or chronic illness who feel heard, valued and respected by their care managers are more likely to take an active role in their own care, leading to improved outcomes and lower costs, research shows.

The authenticity of the care manager-client relationship—how genuine and consistent the patient perceives the provider to be—also makes a difference, some studies have found. And though learning how to build relationships takes time and training, the investment pays off in several ways.

For instance, a 2013 study published in Health Affairs looked at 33,000 clients in a large healthcare system and found that costs were 8-21 percent higher for clients with very low activation levels compared to costs for clients with the highest activation levels. What leads to higher activation? Relationships.

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