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New Horizons in Healthcare Case Management: Benchmarks, Metrics and Models

  • ID: 2075747
  • Report
  • 200 Pages
  • Healthcare Intelligence Network
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To adequately prepare for 2012 and beyond, healthcare organizations should anticipate a centralized case management approach for optimal resource management and consumption, advise leading industry thought leaders. Healthcare case managers are hailed as having significant impact on service utilization, management of chronic illness and healthcare costs.

The 200-page New Horizons in Healthcare Case Management: Benchmarks, Metrics and Models examines the latest trends in healthcare case management, the impact of case managers across the care continuum and what's working in embedded or colocated case management, an emerging strategy of positioning case managers inside primary care practices.

This resource is illustrated with more than 90 figures and tables and answers more than 50 questions on patient-centered case management.

Market research by the Healthcare Intelligence Network indicates that 85 percent of healthcare organizations are using case managers, with many companies co-locating case managers alongside healthcare providers.

Report Highlights:

Actionable data from 201 healthcare companies on:
- Current and planned healthcare case management programs;
- Populations and conditions targeted by case management efforts;
- The top five responsibilities of the healthcare case manager;
- Work locations and average case manager case loads;
- Tools to identify patients most in need of case management;
- Tactics to evaluate a case manager's performance and program impact;
- Overcoming barriers to case management;
- Impact of healthcare case management on utilization, member/patient satisfaction and ROI.

Case management metrics across the care continuum, including:
- Number of organizations whose case managers are the primary patient educators;
- Percentage of case managers conducting post-discharge home visits;
- Percentage of case managers embedded or colocated in physician practices and other points of care;
- Case management for reducing hospital readmissions and avoidable ER visits;
- Contribution of case management to patient satisfaction and experience.

The medical home case manager:
- Building physician practices buy-in for embedded case managers;
- The case manager selection and training process;
- Identifying patients that would benefit best from this type of case management;
- Skill sets, roles, tools and responsibilities of the embedded case manager;
- Case load management;
- Real-life examples of patient self-management patient action plans;
- Results from the Geisinger Health Plan's embedded case manager program.

Case managers in the primary care practice:
- Readying a practice to receive case managers;
- Guidelines for embedded case manager skills, selection, funding, case loads and job responsibilities;
- Target populations and member stratification strategies;
- Contributions of pharmacists to CDPHP's Enhanced Primary Care effort;
- Benefits of home-based telemonitoring;
- Guidelines for integration of primary and behavioral health in a physician practice;
- Lessons learned from embedded case manager pilots.
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Chapter 1: 2011 Benchmarks in Healthcare Case Management
About the Healthcare Intelligence Network

Executive Summary
2011 Survey Highlights

Key Findings
Case Management Program Details
Case Management Results and ROI


Respondent Demographics

Comparison of 2010 Data to 2011 Data

Analysis of 2011 Responses
Overview of Survey
The Health Plan Perspective
The Hospital Perspective

Respondents in Their Own Words
Key Case Manager Responsibility: Health Plans
Key Case Manager Responsibility: Hospitals
Successful Interventions and Partnerships: Health Plans
Successful Interventions and Partnerships: Hospitals
Program Success Factors: Health Plans
Program Success Factors: Hospitals
Key Contribution of the Case Manager: Health Plans
Key Contribution of the Case Manager: Hospitals
Planned Program Expansions: Health Plans
Planned Program Expansions: Hospitals


Responses to Questions

Part I: Overall Survey Responses
1:01: Utilizing Case Managers
1:02: Adding Case Managers in the Next 12 Months
1:03: Populations Targeted by Case Managers
1:04: Case Manager Work Locations
1:05: Participant Referral Methods
1:06: Average Monthly Case Load
1:07: Case Manager Duties
1:08: Case Manager Communication Tools
1:09: Case Manager Educational Background
1:10: Evaluating Case Manager Performance
1:11: Diagnosis Most Impacted by Case Management
1:12: Impact of Case Management
1:13: Case Management ROI

Part II: Responses from Health Plans
1:14: Respondent Organization Type
1:15: Health Plans: Utilizing Case Managers
1:16: Health Plans: Populations Targeted by Case Managers
1:17: Health Plans - Case Manager Work Locations
1:18: Health Plans - Participant Referral Methods
1:19: Health Plans - Average Monthly Case Load
1:20: Health Plans - Case Manager Duties
1:21: Health Plans - Case Manager Communication Tools
1:22: Health Plans - Case Manager Educational Background
1:23: Health Plans - Evaluating Case Manager Performance
1:24: Health Plans - Diagnosis Most Impacted by Case Management
1:25: Health Plans - Impact of Case Management

Part III: Responses from Hospitals
1:26: Health Plans - Case Management ROI
1:27: Hospitals - Utilizing Case Managers
1:28: Hospitals - Populations Targeted by Case Managers
1:29: Hospitals - Case Manager Work Locations
1:30: Hospitals - Participant Referral Methods
1:31: Hospitals - Average Monthly Case Load
1:32: Hospitals - Case Manager Duties
1:33: Hospitals - Case Manager Communication Tools
1:34: Hospitals - Case Manager Educational Background
1:35: Hospitals - Evaluating Case Manager Performance
1:36: Hospitals - Diagnosis Most Impacted by Case Management
1:37: Hospitals - Impact of Case Management
1:38: Hospitals - Case Management ROI


2011 Healthcare Case Management Benchmark Survey Tool

About the Contributor

Chapter 2: Case Management Metrics Across the Continuum

Overview: Case Management in 2011
2011 Survey Highlights

Metric 1: Patient Education and Outreach
15 Steps to Improve Patient Education and Outreach

Metric 2: Medication Adherence
Case Management Approach to Medication Adherence

Metric 3: Obesity and Weight Management
The Future of Disease Management

Metric 4: Managing Care Transitions Across Sites
6 Approaches to Care Transition Barriers

Metric 5: Home Visits
Home Visit Pilot Reduces Unplanned Readmissions

Metric 6: HRAs in Case Management
Using HRAs to Identify Risk in the Elderly
5 Domains of Patient Assessment for Case Selection

Metric 7: Reducing Avoidable Emergency Room Visits
Case Management Strategies for High-Utilization ED Patients

Metric 8: Reducing Hospital Readmissions
A Multidisciplinary Approach to Reducing Rehospitalization Rates

Metric 9: Patient-Centered Medical Homes
Embedding Case Managers in the Primary Care Practice

Metric 10: Improving Patient Experience & Satisfaction
Patient Satisfaction and ED Case Management
Patient Satisfaction a Reality of Healthcare


For More Information

About the Contributors

List of Figures
Figure 1: Case Manager Utilization
Figure 2: Case Manager Work Locations
Figure 3: Primary Patient Educator
Figure 4: Primary Contacts for Medication Adherence
Figure 5: Case Management in Disease Management
Figure 6: Primary Coordinators of Care Transitions
Figure 7: Transitional Care Statistics
Figure 8: Primary Conductors of Home Visits
Figure 9: 4 Reasons to Conduct Home Visits
Figure 10: Reviewers of HRA Results
Figure 11: HRA Outputs
Figure 12: Uses for HRA Data
Figure 13: HRAs Linked to Care Management Program
Figure 14: Staffing Models to Reduce Avoidable ER Use
Figure 15: 5 Reasons to Embed a Case Manager in the ED
Figure 16: Strategies to Reduce Readmissions
Figure 17: Primary Responsibility for Reducing Readmissions
Figure 18: Stratifying Patients into Care Management
Figure 19: Professionals on the PCMH Team
Figure 20: Embedded Case Managers
Figure 21: Details of Embedded Case Management
Figure 22: Primary Responsibility for Improving Patient Satisfaction
Figure 23: Impact of Case Management on Patient Satisfaction
Figure 24: Scorecard Example for Unblinded Patient Satisfaction

Chapter 3: The Medical Home Case Manager

Payoffs of Placing Geisinger Case Managers at Primary Care Sites
Medical Home Model: The ProvenHealth Navigator
The Embedded Case Manager
Selecting a Case Manager
Case Manager Skill Sets and Key Qualities
Case Manager Training and Support
Identifying Target Populations for Case Management
Post-Discharge Case Management
Case Management in Home Health, SNFs and Care Transitions
Success from the Case Manager Effort

Healthcare Case Management: Focus on Care Transitions and Continuity
Survey Highlights
Key Findings
About the Survey
Respondent Demographics

Q&A: Ask the Experts
What is a Complex Case
Integrating the Medical Home with the Health Plan
Technology Supporting the Medical Home Model
Staffing the Case Manager Call Center
Home Health and Home Visits
Stratifying Complex Patients
Case Manager Competencies
Investment in Medical Home Infrastructure
Targeted Case Management Populations
The Case Manager's Role in the Practice
Engaging the Practice in the Program
Making the Most of the Case Manager Resource
Case-Managing the Sick of the Sickest
Building Physician Buy-In for the Embedded Case Manager
Case Management Tools
Predictive Modeling for Risk Identification
Funding and Reimbursement for the Embedded Case Manager
CCM Certification
Timeline for Program Implementation
Importance of Technology in Program Model


For More Information

About the Contributors

Chapter 4: Case Managers in the Primary Care Practice

Bon Secours Embedded Nurse Navigators Transform Primary Care
Division of Labor in a Medical Home
Three Phases of the Advanced Medical Home
Care Team Formation
Efficient Use of Registries
Identifying Case Loads and Levels of Patient Management
Tools to Support the Embedded Case Managers
Measuring Success Metrics

The Role of the Embedded Case Manager in Clinical Transformation
History of the Enhanced Primary Care Program
Steps to Practice Transformation and Payment Reform
Analyzing Savings in a Pilot Practice

Implementing Embedded Case Management
Incorporating the Triple Aim Initiative
Expanding Programs and Practices
5 Criteria for Selecting Practices
Impact of Practice Transformation
Stratification and Prioritization
Primary Day-to-Day Nurse Roles and Responsibilities
Reducing Gaps in Care
Case load and Schedules of an Embedded Case Manager
Collaboration with Pharmacies
High-Risk Populations and Dual Diagnosis Care
Identifying Desired Outcomes
Costs Associated with Embedded Case Managers
Outcomes and Lessons Learned

Q&A: Ask the Experts
Adding RN Case Managers
Training Process for Case Managers
Case Manager Productivity Benchmarks
Completing Pre-Huddle Reviews
Licensing SARG
Case Manager Cost Savings
Physician Incentive Model
Determining Patient Risk
Case Management Certification
Further Case Management Training
Relative Readmission Index
Utilizing Evidence-Based Teaching Tools
Observation Stays
Partnering with Health Plans
Incentives for Case Management Activities
Utilizing the Model in Specialty Practices
Hospital Affiliations and Influence
Program Implementation and Demographics
Allocation of Care Management
Case Manager Outreach
Use of MyChart Patient Portal
Payment Models
Case Manager Background
Choosing Case Managers
Embedded Case Manager Tools
IT Capabilities
Allocation of Staff
Locating Care Managers
Case Manager Communication Methods
Identifying PMPM Cost
Partnering Case Managers with Newly Diagnosed Patients
Gauging Member Satisfaction and Service
Patient Cost for Case Management
Affiliation of Embedded Nurses


For More Information

About the Contributors
Note: Product cover images may vary from those shown
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