In the 1980’s DRG’s created an urgency to address the “episode of care” through diligence in discharge planning and lowering the length of the stay. In the 1990’s case management developed roots in community-based care, most importantly with transitions in care and closing the gap between hospital and home. In 2000’s there was greater expansion into payer concerns and into ambulatory care as part of Accountable Care Organizations (ACO’s). Case Management has become a profession that addresses not just the acute episode of care, as it did in the 1980’s, but the full continuum of care. Today, the discipline finds itself once again, advancing into new sites of care and genres in which to practice.
Once again, the discipline encounters a new opportunity in the management of health care as we knew it. The COVID-19 public health crisis threatens our already fragile health care infrastructure, which is coincidentally the structure that created the need for care coordination. This pandemic has forced the re-examination of the health care “system” as its current failures become more apparent.
Case Management has many definitions, but all share a common theme or core principle of integrating an individual’s unique health journey into a complex, sometimes highly dysfunctional health care system. This profession serves the common goals of managing quality, cost, and patient-centeredness. The discipline itself, better known as Care Coordination, takes in the partnership between RN Case Managers and Clinical Social Workers, while helping to focus the intent of direct health care providers into actionable results. The patient’s best interests form the center of activities that also ensure cost containment and improved management of acute and chronic illness. As a result, case management has new visibility and value across the entire health care spectrum.
Case Management & Innovation
A report issued by the Healthcare Leadership council “National Dialogue for Healthcare Innovation,” exposed 3 areas in which Health Care Has been forced to focus on since the pandemic. The report speaks to the urgency to Improve Data, Innovate Care Delivery Approachs and Stregthen the Supply Chain. Case Management practices have long been focusing on these critical factors.
Improve Data: Case Management practice is a strong influencer in health care outcomes, but data has been too generalized to undeniabley validate direct connections between case management (especially ambulatory practices) and important actions. Today, case management uses data to both create a vision for effectively coordinating care (macro level), as well as determining actions that lead to outcomes (micro level). There are far too few case managers at the local level of care that have the oportunity to view and act upon data. The Center for Case Management has developed an interactive dashboard (built within the organizations own system) to provide visibility of data for both leadership and direct staff.
Innovate Care Delivery: Case Management and Social Work, while continuing to provide traditional duties of utilization management, discharge planning, and helping people with their basic needs, has increased the footprint of support to embrace patients and families in managing the more complex aspects of health care navigation and patient activation. The profession has grown from inpatient/episodic support to managing the entire care continuum. It is Case Management that addresses the impact of the transition period between hospital and home as well as the complicated factors that empower patients to recover and/or manage chronic health conditions.
Strengthen the Supply Chain: While the report speaks to the equipment and supplies, case management/social work has increased the footpring and availability of services, ensuring that there is access to the human supply chain of talented and skilled individuals to help navigate the continuum of care.
Case Management & Telehealth
Research supports the efficacy of remote case management or tele-health services in a medical community forced to adapt to the demands of this new public health crises. We are seeing a growth in the networks that surround telehealth; and Case Management has become integral to this effort.
While it will always be critical to provide face to face interventions, we must reimagine what that looks like in case management and social work. Three factors have driven this change: the need for social distancing during the pandemic, widespread availability of tools such as Zoom, Skype and FaceTime, and increasing comfort with these tools in all realms: family contact, education, and professional encounters. Every effort is now being used to embed technology available to both the patient and the case manager for a successful interview and ongoing interventions. While virtual face to face is considered the most effective, not everyone will have this capacity. Preparing for an assessment should take into consideration both a virtual solution and a telephone call.
Case Management should look to the telehealth community to integrate skills sets in helping high risk and chronic care patients (of which COVID is a new subset), manage the continually challenging landscape of the healthcare. As with onsite case management services, ambulatory, remote, and telehealth case management will contribute the unique ability to support patients as they navigate the clinical, financial, and psychosocial aspects of their situation.
Case Management today has evidence-based standards that are relevant in any setting: face to face or remote. RN’s and Social Workers professionals work in the service of the patient and family, but also within the context of the reality of reimbursement and the needs for efficiency. Nurses, social workers, physicians, and others working in case management provide the engine that drives coordinated care as each patient and family receive a customized journey into and throughout their health care journey.
