Collaborative Case Management is emphasized by accreditation organizations such as URAC and also by national case management standards of the Case Management Association of America.
Collaborative case management involves a plan of care developed with the patient and emphasizing patient- centered services. It is a useful method that demonstrates both a cognitive reasoning approach and documentation required by URAC standards, a care plan approach provides effective case management.
National case management program accreditation standards clearly define case management functions to include patient health assessment, identification of problems amenable to case management, statement of client-centered goals (both long and short term), planned intervention strategies and, of course, care plan evaluation. Obviously, patient assessment is different than information assessed while providing direct patient care – or is it? Aspects of assessment in either situation include current health status (both physical and psychosocial) and clinical history, including medication – related inquiry regarding the level of knowledge the patient has about his or her own medications, resources (family, health provider, etc.) available to provide assistance, and discharge planning needs. The process continues… based on accurate and ongoing data that is reliable and thought about, needs are identified that can be addressed through collaborative case management intervention. Then what?
URAC standards cite the process of care planning to include development of long-term goals (based on specific patient assessment data collected) and short-term goals that detail the incremental steps to be taken in order to reach the long-term goals, such as patient “ seeks to increase level of physical functioning within 4 weeks,” or “will demonstrate safe self-management of medications.” In figuring out goals, what creative and necessary case management intervention is required to meet the specific needs of your patient? What resources are necessary to achieve the stated goals? What time frame is realistic for the goals to be met or the coordination of resources to occur? The patient is involved every step of the way! If the plan does not work, an ongoing evaluation will let you know, that it is time to plan a different path, or revise the path that was taken.
Now, more than ever, the role of the case manager has increasing importance with current accreditation requirements to ensure a safe transition of care from hospital or other health facility to home or other setting. Although computer systems can assist in “thinking,” they cannot replace a thoughtful and caring case manager who is capable of using the knowledge and skills to effect safe and clearly reasoned direction for specific patient needs.
Professional Services Network, Inc. (PSN) works with clients nationwide in the search and recruitment of experienced healthcare professionals in managed care and clinical roles for temporary assignments and direct hire opportunities. Additionally, PSN’s consultants work with organizations and providers seeking accreditation or re-accreditation with URAC or NCQA. For additional information regarding our services contact us at 301-460-4089 or email us at [email protected].
