Case Management and Healthcare Blog

Support for Patient, Families is Key in Each Stage of Disease 

Dementia is a general term used to describe a decline in mental ability severe enough to interfere with daily life. Family members, healthcare providers, and care managers face special challenges in supporting and caring for people with dementia.

In the early stages of dementia, patients and families may notice the patient has increased difficulty in coping with transitions, subtle changes in short-term memory, difficulty finding the right words, and instances of repetition, such as asking the same questions or completing the same tasks repeatedly. Families will sometimes report their loved one is confused about their sense of direction, struggles to follow storylines, or exhibits sudden changes in mood, such as depression, frustration, and anger.

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Care Management Training is Key to Effectively Addressing Diverse Needs

One could argue that health plans use case managers in much the way a financial advisor manages a client’s portfolio. By evaluating the client’s needs and determining how to provide care efficiently using the resources at hand, care managers are able to keep costs down and ensure clients get the best care possible.

On the surface, it is easy to think the job description for a case manager is simple and straightforward, but the role has many moving parts, requiring a skill set that ranges from expert communicator, to adept multi-tasker, to team player and coach.

Case Managers Play Multi-Faceted Role

Care managers wear many different hats and function in a multi-faceted role that grows in complexity with challenging client cases. Health plan case managers are mediators, educators, negotiators, moderators, and experts. From day-to-day, the case manager must work with clients, providers, and payers, each with a distinct view of what constitutes appropriate care.
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New Tools Make Communication Easier, but Case Management Outreach Still Key

For case managers, the key to helping patients adhere to their treatment plans is to make the process easy. According to the World Health Organization (WHO), a lack of doctor-patient communication is one of the biggest reasons patients are not compliant with their healthcare plan. Lack of compliance places a financial burden on society, ultimately increasing case management workload and healthcare costs.

One clinical study found that focusing on education and follow up with patients resulted in better compliance, and therefore better outcomes. Those who received careful education and were engaged with providers and case managers demonstrated a better understanding of their diagnosis and the recommended treatment.

How can case managers make engagement easier for the clients and patient they serve? One approach is by utilizing technology that’s already a part of their daily lives.

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Case Managers Improve Communication Among Patients, Providers, Pharmacists

Nearly 133 million Americans—more than 40 percent of the total population—are affected by chronic and generally incurable diseases. This number is projected to grow to an estimated 157 million, including 81 million with multiple conditions, by 2020.

Not surprisingly, more than 75 percent of all healthcare costs are related to chronic health conditions, such as diabetes, heart disease, hypertension or mental illness. The treatment of these and other chronic illnesses commonly includes long-term medications.

Yet the full benefits of many medications may not be realized because an estimated 50 percent of patients do not take them as prescribed. A key role of care managers is engaging patients to consistently take their prescribed medications.

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Care Managers Use Knowledge, Empathy to Assist Clients Struggling with Addiction

Case managers are on the front lines of an opioid epidemic that is responsible for indiscriminately taking lives and destroying families. Every day more than 130 people in the U.S. die from an opioid overdose resulting from the misuse and addiction to prescription pain relievers, heroin, and synthetic opioids such as Fentanyl. This epidemic is a serious national crisis affecting public health, and social and economic welfare.

The Centers for Disease Control and Prevention (CDC) estimate opioid misuse in the U.S. creates an economic burden of $78.5 billion a year. The statistics are staggering:

• Nearly 29% of those prescribed opioids will misuse them
• Up to 12% develop an opioid use disorder and an estimated 6% who misuse prescription opioids will transition to heroin
• Opioid overdoses rose by 30% in the year between July 2016 and September 2017 in over 45 States, while the Midwest experienced overdose increases of 70%

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Assessing Social Determinants of Health

Healthcare and homelessness are inextricably linked; homelessness is a social problem with enormous public health significance. It may exacerbate medical conditions such as diabetes, heart disease, or addiction, or those conditions may weaken a person’s financial stability and become a risk factor for homelessness.

As a case manager, you are in a unique position to assess social determinants of health impacting your clients. Identifying risk factors that may increase your client’s potential of homelessness helps you to proactively engage strategies to reduce the risk. It is nearly always easier to prevent the problem than to try to rectify it later.

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Relationship Building 101

Customers don’t buy from people they don’t trust, and the same is true in healthcare. As a case manager, you have the opportunity to make a significant impact on the level of trust your clients experience within the system, and therefore the outcomes they enjoy. You’re not just providing a service, but building a relationship with the goal of developing trust.

Over the past several years a proliferation of benefit designs and new delivery systems have moved healthcare beyond a traditional brick-and-mortar office, into retail and virtual settings. Consumers now have more choices than ever before.

Since health is one of the most important assets anyone has, it takes trust to allow someone close enough to effect a change. To impact the lives of others, clients have to be able to trust that you have their best interest at heart and will be their advocate.

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Effective Interviewing Techniques are Key for Care Managers

Famed motivational speaker Anthony Robbins hit the nail on the head with this quote on what leads us to life-changing, life-affirming behavior: “The quality of your life is a direct reflection of the quality of the questions you are asking yourself.”

If you’re a care manager, the same principles apply to the quality of questions you ask a chronically ill patient as you develop an effective care plan. In other words, only when you ask the right questions will you get the answers you need.

Asking good questions, however, takes practice and training in strategies like motivational interviewing. You aren’t born with great interviewing skills! A good interviewer can get a patient to reveal information without realizing what was said − significantly helping the healthcare team form a strong plan of care.

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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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