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.
Lead with Language Your Patient Understands
Effective communication skills are an important skill in your toolbox. Communication has always been a vital component to healthcare service and a fundamental way to improve quality care. You are responsible first and foremost for your own communication skills and enhancing those to build trust with your patients as effectively communicating health information and planning improves patient satisfaction.
Clear communication also leads to better health outcomes in specific chronic diseases, including a significant reduction in mortality from heart disease, improving the control of diabetes and better medication compliance with high blood pressure. These three conditions represent a large portion of chronic illnesses in the U.S.
Data demonstrates many healthcare providers do not talk with their patients using vocabulary patients understand. Medical care is full of jargon, most of which patients don’t recognize. Other factors that may interfere with the ability to communicate clearly include your own perception of the world, client bias and an inability to set aside your personal reactions.
Negative outcomes from ineffective communication include increased readmission rates, and worsening disease due to poor follow through. Malpractice claims are also more common when patients perceive communication with their provider to be humiliating or degrading.
Help Patients, Providers Set Clear Guidelines and Expectations
As with any other relationship, outcomes improve when clear guidelines and expectations are understood by both sides. To improve patient perception of a successful outcome and reduce legal liability sometimes triggered when patients have a different idea of what is expected in their medical condition, it is important to set a clear idea of the definition of what is a positive outcome.
When you understand your patients’ expectations you can enhance their level of satisfaction, which in turn raises the potential they follow their health care plan and experience positive outcomes. Setting expectations based on your patients’ abilities and life circumstances early in your relationship improves outcomes and reduces admission rates.
Patients rely on you to help them set expectations before, during and after admission into the hospital system or changes in treatment plans in the community. Expectations often drive a client’s ability to integrate information successfully and follow a plan of care.
Identify and Work With Patient Advocates
Patient-centered care is not just better for the patient, but it is also crucial to the success of the healthcare system. Engaging a patient advocate in the hospital setting helps ensure a patient feels heard and gets the care they want and need.
A patient advocate may be employed by the hospital or health system, may be hired as an independent professional, or may simply be a close friend or family member of the patient. In any case, the advocate acts as the navigator, helping the patient to understand the process and options they may have.
Working closely with an advocate increases your insight into your patient’s opinions and sentiments you may not have otherwise been privy to. Now you have a stronger basis on which to plan and execute positive strategies.
Don’t Let Care End at the Hospital Door
Researchers find continuity of care improves quality of care while reducing avoidable hospitalizations and emergency department visits, and enhancing a patient’s participation in preventive services.
In a systematic review of articles, researchers analyzed data from 18 studies and found there were none documenting negative effects from increasing sustained continuity of care.
In fact, sustaining continuity of care increased patient satisfaction and outcomes. The researchers concluded this improvement in care was most consistent in clients who suffer chronic medical conditions, such as diabetes or heart disease, and resources may best be maximized by focusing on those populations.
Encourage Transparency
Patient outcomes are significantly impacted by the quality of the medical diagnosis, treatment decisions, and ongoing monitoring of care. Poor decision-making or care protocols don’t change unless results are analyzed and published to ensure the same mistakes are not made twice.
Still, transparency is easier said than done. Hospitals and health systems may understand the need for transparency and outcome reporting, but fear the public scrutiny that comes with releasing such information. Many measurements do not gauge quality but are rather metrics used to capture compliance with healthcare guidelines.
In a 2010 white paper, the American College of Physicians said transparency is vitally important and can “improve quality, safety and efficiency throughout the healthcare system due to competition and/or the availability of clinical benchmarks.”
SOURCES
CMS Value Based Programs, Centers for Medicare and Medicaid Services
Cabana, M., Jee, S., (2004) Does Continuity of Care Improve Patient Outcomes? The Journal of Family Practice, 53(12)
Chou, C., (March 28, 2018) Time to Use Evidence-Based Approaches to Patient Engagement. New England Journal of Medicine Catalyst
Lateef, F., (2011) Patient Expectations and the Paradigm Shift of Care in Emergency Medicine. Journal of Emergencies, Trauma and Shock, 42(2):163
American College of Physicians, (2010) Healthcare transparency—focus on price and clinical performance information.