Strategies to Elevate Every Care Coordination Practice

Case Management Strategies to achieve success.

Case Management Strategies to achieve success.

In keeping with the framework from Focusing on the Future of Case Management, where the discussion centered on team members, general processes, and collaboration, this Insight provides the supporting rationale for evidence-based care coordination (aka case management) program strategies along with the associated outcomes:

  • cost-effective care,

  • better patient outcomes and

  • enriched patient experience.

However, before diving into the strategies and the supporting rationale,  Integrated Care Strategists reminders leaders to obtain achievable and sustainable transformation, leaders must first actualize the importance of their role and the team's change journey.

With that said, there are four strategies of primary focus----staffing, care coordination activities, a transition of care program, and patient/family involvement.

Staffing

Assuring the appropriate complement or allocation of staff to the assignment is the cornerstone of all the strategies. The lack of appropriate staffing impacts the effectiveness of the assessment, care planning, care coordination, and patient self-management support.  Whether it is moving case managers to different areas, changing assignments, or not having enough case managers, it impedes their ability to process the information received to develop a plan of action or complete the associated tasks.  Hence, the role's priorities and pressures start impacting the work quality, resulting in less than desirable outcomes such as missed or scant assessments, untimely continued stay reviews, or being unprepared for treatment team meetings because they do know the patient's needs or history.

Likewise, employee engagement becomes impacted because of inappropriate staffing or complement of staffing.  Unbalanced staffing creates a sense of being devalued and produces anxiety in the care coordinator, thereby affecting relationships with patients, families, and other healthcare providers.  It hinders the case manager's ability to be supportive, empathetic, and confident.  For all of these attributes are needed to increase the likelihood of patients becoming involved in their care.  When case managers are engaged, patients and families are more likely to be involved in the care because they feel respected and empowered from the relationship established with an unhurried, sensitive case manager. Thus, increasing self-management, which decreases further healthcare utilization and costs.

Care Coordination Activities

Care coordination involves assessing, diagnosing, planning, implementing and evaluating (irrespective of the level of care).  However, there are two aspects of the patient's health that are typically not integrated into the assessment, impacting the entire care coordination process.  Those two attributes are mental health and health literacy influencing cost, clinical outcome, and patient experience.

Essential to the goals is incorporating behavioral health into the assessment, which allows for the planning of appropriate interventions and collaborations. The 2018 Milliman Research Report estimated that in 2017, patients with behavioral comorbidities increased healthcare costs by $406 billion in the United States.  Additionally, the report estimates a potential savings of $38 billion to $68 billion with the integration of medical and behavioral services.  The same is true for improved health outcomes and patient experience.  

Multiple studies focused on collaboratively (including a case manager) managing depression and chronic medical conditions. The medical conditions in the studies were chronic pain, diabetes mellitus, and cardiovascular disease.  Each study demonstrated improved outcomes for the behavioral health issue and medical condition.  In chronic pain, integrated care resulted in a moderate reduction in pain, disability, and depression.  As for diabetic patients with a concomitant mental health issue, they experienced a decrease of ≥ 1% hemoglobin level from baseline and significant improvement in their depression.  With coronary heart disease, 40% achieved depression remission or response and 58% blood pressure control during a mean follow-up of 11 months. 

The second one is the patient's health literacy.  Health literacy can be subdivided---healthcare system literacy and patient/family health literacy. 

According to Accenture research, low healthcare system literacy costs an estimated $4.8 billion annual administrative expenditures translating into about 52% of healthcare consumers. The study further reveals that an individual's educational level is not necessarily a factor in determining literacy.  In fact, 97% of low healthcare system literacy consumers graduated high school, with 48% completed college.  This struggle becomes apparent when they try to make informed decisions about appropriate health plan coverage to healthcare providers to health care procedures.  All important factors for case management teams to know and understand when working with patients and families, especially during transitions.

As for patient/family individual health literacy, the Institute of Medicine of the National Academies' study indicates only 12% of Americans have proficient health literacy.   Additional research denotes low health literacy is associated with adverse health outcomes, including increased mortality and at greater risk for unfavorable transitions to post-acute providers.

Transition of Care Program

The national and global priority of improving patient safety and quality during the patient transition of care dovetails with the strategies of this Insight---cost-effective care, better patient outcomes, and enriched patient experience.

Recent research reveals that effective discharge planning and implementation when moving a patient from one level of care to another averts costly and avoidable readmissions and prevents adverse events, including medication errors, notably for Medicare patients transitioning from inpatient to another setting.  When a transition of care program implements a standardized template, the evidence of safer outcomes becomes more robust.   Examples of models that demonstrate patient safety are Better Outcomes for Older adults through Safe Transitions (BOOST), the Care Transitions Intervention (CTI), and the Transitional Care Model (TCM). 

Patient and Family Involvement            

The rationale for involving the patient and family when striving to achieve cost-effective care, better patient outcomes, and enriched patient experience goes beyond the Center for Medicare and Medicaid Services and The Joint Commission requirements.  Patient and family advocacy, along with self-management, is at the heart of this strategy.

Half of Americans do not understand how to maneuver through the complex healthcare system.  They do not always understand all the underpinnings or definitions, such as "required criteria for placement, prior authorization requirements, in-network vs. out-of-network, skilled nursing facility vs. nursing home, advance directives vs. power of attorney, etc. 

Another study discussed the factors associated with readmission prevention.  Many factors are related to the patient's lack of awareness of whom to contact post-discharge, inability to keep provider appointments, and lack of discussion about care goals.

Hence, the importance of involving patients and families in care discussions (and the giving of information) along with decisions during the discharge process is a key component to achieving safe transitions.

Conclusion

For the average hospital, avoiding one excess Medicare readmission results in a reimbursement gain of $10,000 to $58,000.  Higher mortality rates increased healthcare costs, and greater social service utilization chances exist when patients with complex care needs go unmet.  These two facts highlight the importance of bracing these strategies, which are pivotal to elevating a care coordination program. As mentioned above, the strategies produce positive outcomes in attaining cost-effective care, improved patient outcomes, and a bolstered patient experience.  Lastly, the more strategies implemented, the greater the odds of receiving a top CMS star rating, reflecting the overall quality.

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