Case Management and the Coordination of Care

The delivery of care that is based upon reducing costs while delivering better outcomes is becoming more and more important today. It is often termed ‘value based care’. It will be the basis of much future reimbursement models whether from private or government payers. Currently, providers are rewarded bonuses for providing this care, especially in patient-centered medical homes and accountable care organizations. One of the keys to achieving better care at lower costs is the integration and coordination of care among providers. The use of a case manager is an excellent way to achieve these goals.As stated on the GE Healthcare Camden Group Insights Blog in the article “7 Steps to Achieving Clinical Integration”, “New payment models are making it more important than ever for hospitals to collaborate with physicians. From readmission penalties to bundled payments to ACOs, providers have a growing economic incentive to pool resources, share information, coordinate care and services and cooperate on quality improvement.” Again, the case is made for effective management among hospitals, providers, and payers.In a recent interview a former manager at a local hospital was describing to me the goals of case managers at a hospital. At the hospital, a case manager is to manage the discharge of the patient from the hospital so as to prevent readmission for the same cause as the initial admission, as hospitals are penalized for doing so. In an interview with my son, who is an RN and was employed as one for a large, national payer, the goal of a case manager was to minimize the costs of medical care for the patient while providing good care. The goal of the case manager in a physician group is to drive down risk, to improve the quality of care, for the patient. The goals of case managers at all three types of sites is the triple aim-improve population level health, improve patient satisfaction and drive down costs.How do case managers at each of these three sites reach their goals? What is their scope of work at each site? In a hospital setting one typically coordinates the discharge of a patient. This is a very complex task and is fairly new to many hospitals. One make sure that patients have a follow-up appointment with their primary care physician or specialist within two weeks after discharge or sooner if medically necessary. At discharge she will confirm with the patient the date and time of the follow-up appointment. If there is a problem with getting transportation to the appointment then the she will work to find ways to get the transportation, including working with the insurer if needed.The hospital case manager will also go over the discharge instructions from the doctor, explaining what the patient needs to do once she is at home. For instance, in the case of knee replacement surgery the manager will explain to the patient what to do to manage pain, what exercise the patient will need to do at home, including visits from a physical therapist if it is covered. He will also discuss the care of the incision site and what to do if an infection develops after discharge. Good ones make sure that the patients understand the instructions and that they are able to accomplish them.My son as a one for a large insurer worked with patients who had high risk scores as defined by the insurer. Most had comorbidities. These patients were contacted and asked if they wanted to work with a case manager. If they answered yes, then he would contact them and provide insights into their conditions through education. If he discovered that they were not receiving all the medical help that they needed according to standards of care for their condition he would offer to make appointments for them with their doctor. If they could not afford their medications, he would work to find a way to reduce the costs. If they needed transportation to an appointment, he would arrange that for them. In other words, he made sure the patients were getting the level of care needed to effectively manage their conditions so as to prevent progression of conditions to a state that would need more costly care.Case managers in physician practices often do the work that a physician wishes he/she had time to do. For instance, a case manager, having access to details of medical records that managers at other sites do not, may track indicators for patients with serious conditions. He/she may track the A1c levels of diabetics. Registries can help with this. If the level is too high the manager will contact the patient to see if further education is needed. Perhaps the manager will have the patient come in for this education and the two will problem solve how to lower the patient’s A1c level.Managers in the clinical setting also make sure that patients have scheduled appointments when necessary. For a diabetic with poor control they may have the patient come in once a month until the indicators improve. The manager will work with the patient to make sure appointments are available and that the patient can make it to the appointment. For instance, the case manager of the orthopedic clinic that my wife uses has set up two post knee replacement appointments.As one can see, case managers can be of great assistance in helping patients achieve outcomes so that they can lead lives that have high quality. In doing so they will hit the Triple Aim of healthcare.Case managers can be certified. One body that certifies case managers is the Commission for Case Manager Certification. In order to be certified a case manager generally needs:

A license as an RN, LCSW, Rx or a BA in a social studies field

Experience of 12 to 24 months in a case management field

Pass board exam

Not only do patients benefit from the work of case managers, their employers do also. Hospitals avoid penalties for ‘Never Events’ such as readmission of a patient within 30 days for a condition that was related to the initial admission. Insurers save money by helping patients get care that is less costly, helping them avoid conditions that require intensive care. Case managers in the physician setting help practices achieve rewards or bonuses offered by payers for providing care that has high value and lower costs.

Why Spas and Salons Should Make Use of Water Fountains

If you own, manage or work in a spa or salon and you feel as though there is something missing with your decor, water fountains may be your answer. Contrary to popular belief, these are actually pieces of decor that everyone can afford. Sure, there are still wall water fountains that can be pricey however, there are plenty of budget-friendly options as well.In today’s world, water fountains are one of the first things visualized when people think of a luxury spa. Just the thought of listening to that soothing, running water in the background instantly transports you to some hideaway, sheltered by the rainforest canopy.Surely, you have walked into an establishment and been swept away by wall water fountains in the waiting area or the private room? Well, even if you are just opening a new salon or spa and the budget is tight, you can find inexpensive models that will make your facility look rich and glamorous while creating a peaceful atmosphere.Why You Need ThemAside from the obvious aesthetic benefits, there are other reasons why you want to add water features to your establishment. The calming effect that these pieces of decor offer allow your clients to immediately feel as ease. Even if it’s their first time there and they feel a bit intimidated, water fountains will relax them so their anxiety levels decrease and they are able to fully enjoy their experience.Not only that, they politely drown out unwelcome noise. You may not notice how obnoxious phones ringing, conversations, hair dryers, etc., can really be, especially to someone who is looking for a brief quiet escape from their busy life.Which One Should You Choose?Water features are like potato chips, it is extremely hard to have only one! Even if you start with one, you will find that they are contagious and you will want to quickly add additional ones to your collection.Wall water fountains are perfect for entryways, waiting rooms, long hallways or any other rooms where you have a lot of wall space. Floor fountains can also be nice as long as they are out of the way. These are ideal in corners, private rooms or changing rooms where there’s not heavy traffic.Of course, tabletop fountains can be placed pretty much anywhere. Tables, counters or shelving, anywhere you need a little tranquility, a fountain can make it happen.

Mind, Body, Spirit – Healing is Possible

Nearly every day, it seems, I hear from people who have given up. It’s most unfortunate. “I have THIS,” they say. “The doctor said so. There’s no cure.”"I take the pills, but they really don’t work. I still feel bad, and the pills make me feel worse. There’s no cure. It’s hopeless. I am doomed to a life of pain.” Or poverty. Or loneliness. The “affliction” may be different, but the essence of the situation is the same. Things look grave, and the person is overwhelmed.Here’s what I really want to know. Where is the doctor, or the relationship expert, or the financial advisor who really said that things were hopeless? Generally nowhere to be found.* The doctor may have genuinely said, “I don’t have any more to offer you.”* The financial advisor could have said, “You are deeply in debt.”* The relationship expert might have expressed, “You sound extremely needy — like a victim.”Each of these statements expresses an objective expert view of your current situation, and it may not be pretty. But generally the expert will not suggest that you give up. You conclude that things are hopeless based on the fact that the things you have tried up until now have not worked as you’d hoped they would.In my world, each of the three “expert” statements says the same thing. The conventional way of doing things … the strategies you’ve always followed up until now … have not gotten you where you truly want to end up. Therefore, it’s time to try something else.A number of years ago I attended a seminar. The gentleman leading our group made a profound statement of perspective. “If I went to the doctor and he told me I’d be dead in six months if I followed his advice,” the gentleman began, “I think I’d look for a new doctor.”What if we were all to follow that logic? The gentleman leading my seminar lived from a position of “of course there is a solution, I’ve just got to find it.” So many of the people I meet could have richer lives than they ever imagined if they could find their way to that place. I suppose we all could, because to a certain extent we are all “blind” to our “blind spots.”Let’s consider how life might look from a position of “Healing is always possible!”The first thing we’d want to explore is a definition of healing. Wholeness, they call it. Peace of mind. Expressing the fullness of “you” with nothing missing or left out. Wholeness is the domain of the spirit, and it is always within your reach. There are two things to let go of in order to reach the state of wholeness, abundance, or belonging that you may so deeply desire.1. Let go of the illusion that “you” are in charge. Allow the reflection of perfection that you call Spirit, Creator, or God to shine through and guide you. You don’t have to figure this all out on your own. Just be willing to follow directions.2. Let go of thinking that the way you have always done things is the only acceptable way to live. How you’ve always done things has gotten you where you are today. Granted, you survived and are still here to tell the story. But if you’re not happy with the story you’re telling, then consider that there may be another way to be. Just try it. If you’re not happy with the way things are now, then what could you have to lose?Having let go those two illusions, there is one major thing to adopt. It is a habit of listening. Ask your deep questions. Then create space in which to hear a response. It doesn’t really matter in whose voice the answer comes back. A radio announcer, a favorite author, an email from a friend, your dog, the Maple in the back yard, or your own familiar inner dialog.Coming from a position of “anything is possible, I simply need to accept the guidance I am shown,” adopt the perspective that any fresh insights you may receive today are pieces of the solution. Don’t judge that they’re impractical or too expensive or too much work. Just try them on. Assume there is a way, and that the way will be shown.Listen. Heal. It is always possible!