Case management is defined as a collaborative practice to facilitate care along a continuum through effective resource coordination, according to the ACMA.  Simply put, it’s a patient-centered process to ensure a clinical team is providing proper treatment to each patient on-time, every-time.  Therefore, a top goal for case managers is to utilize resources in the most effective, efficient way possible, while improving patient outcomes and reducing costs of care.

One way case managers are achieving this goal is through strategic implementation of patient care programs tailored to individual needs.  Case managers are then charged with coordinating all the essential functions needed to successfully execute these plans including clinical team coordination, patient education, staff training, coding, and post-discharge communication.  Hospitals with proper patient care programs run by qualified case managers are now proving that this investment is worthwhile.  Their success shows these programs lead to improvements in quality of care, patient outcomes, and the overall bottom-line.

Improving Quality of Care

Today’s shifting healthcare landscape and regulatory environment is forcing the industry to adjust to a patient-centered approach in treatment programs.  This is great news for patients, but until recently made decision making and coordination difficult for healthcare teams.  With growing demands for case managers to implement effective patient care programs, positive results are beginning to emerge regardless of the dramatic shifts of late.  Measurable improvements in continuity of care and health care provider collaboration are leading much higher rates in patient success outcomes and quality of care reviews.  Some of the solutions patient care programs include:

  • Foster a better patient experience
  • Diminish staff burnout
  • Improve discharge planning
  • Better care coordination and transition of care post-discharge
  • Increased education and information exchange for patients and families
  • Improvements in medication and treatment adherence
  • Greater collaboration and communication across clinical teams and other providers of care

Proving ROI

Rising costs and economic constraints on the healthcare system as a whole are another hurdle these recent shifts have created, making cost efficient care a primary driver for decision makers in the industry.  Improving overall outcomes and lowering the cost per case of clinical care is now a top priority for CFO’s to maintain overall fiscal stability.  With the Patient Protection and Affordable Care Act in full swing, healthcare systems are being forced to become increasingly accountable when providing care.  Additionally, CMS regulations by state has the potential to create thousands of dollars in lost claims if treatment programs are not deemed medically necessary, and patients losing reimbursement will be more likely to give negative reviews.  Case managers and proper patient care programs can benefit executives and fiscal health as well.  Below are a few benefits we have seen so far:

  • Maximized use of available hospital resources
  • Reduce avoidable delays and gaps in care
  • Cut readmission rates and lower re-admission penalties
  • Promotion of safe and cost-effective care
  • Improved claims management by assisting with appeals/denials
  • Manage 2014 IPPS Final Rule

For published results on actual patient care programs, see this report from The Commonwealth Fund.

Apply for a Job with MedPartners

Looking for a New Career? We’d love to hear from you. Please click “apply” to submit a cover letter and resume.
  • * All indicated fields must be completed.
    Please include non-medical questions and correspondence only.

    By providing your mobile phone number, you are consenting to receive text messages from AMN Healthcare. You can unsubscribe at any time by texting “STOP”. Texts are free, though standard text message fees from your cell phone provider may apply. See privacy policy for details.

    By clicking “SUBMIT”, I agree to receive emails, automated text messages and phone calls (including calls that contain prerecorded content) from and on behalf of AMN Healthcare Revenue Cycle Solutions (formerly MedPartners), its parent, AMN Healthcare, and affiliates. I understand these messages will be to the email or phone number provided, and will be about employment opportunities, positions in which I’ve been placed, and my employment with AMN companies. See privacy policy for details.