By Anne Llewellyn, RN-BS, MS, BHSA, CCM, CRRN
As we moved to a value-based health care model, organizations and providers are being evaluated and paid relative to the health outcomes of the population they serve. As a result, many are rethinking how they practice and are making changes to be more in tune with the patients they are called on to care for.
In this post, I would like to ask all reading: how are your metrics? National Case Management Associations and Case Management Certification organizations bodies state that case management is a professional practice made up of nurses, social workers and other professionals whose role it is to coordinate care, educate and empower patients at risk. With the intense scrutiny of finding innovative ways to contain costs, improve quality, and empower the patient to be active members of their healthcare team, isn’t it time for case management professionals to take the time to analyze how they are doing in achieving their core competencies? What metrics can you use to prove the value that Case Managers bring to the healthcare system?
As organizations, politicians, employers and Insurers look for ways to cut cost, showing value and outcomes is critical. In this post, we will look at FIVE core competencies all case managers share. This will allow you to begin the process of showing how you measure up personally and against your peers. They are:
- What is your engagement rate with patients when you open a new case? If it is not good, you might want to find ways to improve. If you are a telephonic case manager from a managed care or telemedicine company, an onsite case manager being called in to manage a case or an embedded case manager from the primary care or specialty practice office, one of the ways to improve your engagement rates would be to work with the hospital case manager and ask to be introduced to the patients. Most times the patient and their families are confused by all the people involved. Hopefully, they have met and talked to the hospital case manager and will be more receptive to another health professional when an introduction comes from someone they know. As case managers, we have to do a better job of working together with our fellow case managers as patients transition to new settings. Traditionally we have not done a good job at transitioning patients from one case manager to the next, so this is one place to start.
- How are you doing in educating your patients and their families regarding their conditions as well as what to look for once they go home to avoid complications?? Today, effective discharge planning to prevent readmissions and ED visits is critical to avoiding penalties in payment. There are many models in place that will help you to better educate and empower your patients. They include: motivational interviewing, patient activation, return to work and behavioral change strategies. Are you up to date on these models? How are your metrics in implementing these models? What changes do you see in your patients as a result of instituting them? These are important questions case managers should be asking themselves on a regular basis. When you find you are not doing well, finding ways to improve is important.
- Do your patients know who to contact once you close their case? Have you alerted them so in case they have questions, they know who to contact? We used to say that our job as case managers is to work ourselves out of a job! This saying is still true, but we also have to remember that patients have questions and depend on us to steer them in the right directions so when issues or questions come up, they know who to turn to in the system to get help. Make sure you have given up follow-up instructions when you close your file.
- Have you provided information to your patients and their families on ways to use social media so it is helpful and does not add to the confusion of being a patient? Helping the patient to understand their health conditions is part of the education case managers provide. Patients who are informed and educated do better overall as they feel empowered to ask questions and find resources they can use to self-manage. Most people turn to the internet for information. As professionals, we know that the internet can confuse and even mislead patients about their conditions. Being aware of credible websites where they can find information is a role each case manager should take seriously.
- Have you improved communication between the healthcare team, the patient, and their families as well as the payer/adjustor? Most of the problems patients have are traced back to poor or insufficient communication. Case managers are viewed as the liaison between the patient, their families, the healthcare team, the payer, and the employer. It has even been said that the case manager is the ‘glue’ that keeps the team together. What metrics can you show that you have improved communication between all stakeholders?
Being effective in today’s disruptive and fragmented healthcare system is not easy. Case managers, regardless of setting, have a daunting task, but honing your competencies, measuring, analyzing and reporting results that will help keep you on track and allow you to show the value you bring to all the stakeholders you interact with is important.
I hope you have found this post helpful. Please feel free to share this post with your colleagues, supervisors and your organizational leadership so you can begin to think about and look for ways to demonstrate the value you bring as a member of the practice of case management.
Resources:
Here are some resources that you might want to view to help you be aware of the competencies all case managers should have as well as how to formulate metrics to evaluate how you are doing. Continuous learning is an important part of professional development!
Required Skills and Values for Effective Case Management
Case Management Standards of Practice
Commission for Case Manager Body of Knowledge
Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
HEALTHCARE PRACTITIONER, LEADER AND EDUCATOR
Anne is a registered nurse with close to 40 years of experience in the healthcare industry. She holds a Master’s Degree in Training and Development from St. Francis University and a Bachelor in Health Services from Barry University. Anne is a board certified case manager through the American Nurses Credentialing Center and the Commission for Case Manager
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].
