Hospital case management is on the rise

Overworked and under-appreciated, hospital-based case managers have not always received the respect they deserve. That is rapidly changing.

The trend of moving from volume-based reimbursement to value-based payments is changing the way hospitals are run. Consider a CABG patient at a typical hospital 10-15 years ago:

A pratice-based surgeon performs the procedure, nurses monitor the patient, and a practice-based PCP performs rounds. If the patient is readmitted to the hospital, then the payer is simply billed for another round of services.

With readmission reduction programs, value-based purchasing, episode-based care, and ACOs, the volume-based model as we know it is on its way out.

Today, a CABG patient is likely to be seen by a team comprised of surgeon, hospitalist, nurse, and case manager. Collectively, this team is not just focused on performing the bypass properly, but also on ensuring that the patient gets well over the long term. This means that the patient must be actively engaged so that they take control of their aftercare. This is where case managers come in. It is case managers who are tasked with raising a patient's health literacy level. It is also case managers who are tasked with organizing post-discharge services. In some cases, case managers visit the patient at home to continue the patient education process and to identify health risks.

By engaging patients, case managers help produce better outcomes while avoiding costly readmissions. Hospitals are just starting to realize just how critical a role case managers play. Even though the value of case managers is clear to hospitals, most hospitals are run on extremely tight budgets. So how does a hospital stretch its care management dollar? Two ways.

  1. Complement case managers with patient-facing technology. With speech-to-text and multiple language support, virtually everyone can use a touch screen tablet. Hospitals should leverage this technology so that patient education isn't limited to the precious few encounters with case managers over the course of a 2-3 day hospital stay. Touch screen tablets can fill patient downtime with an engaging experience that is tailored to them. It can help them understand their condition and meds through interactive graphics, sound,  and video. It can also provide the tools to make all post-discharge appointments.
  2. Identify patient risk pre-discharge. A real-time risk dashboard can display areas of risk based on user inputs. For example, if the software indicates that heart failure patient doesn't understand how to calculate sodium content on a food label, then flag the case manager for some one-on-one time with the patient to work on this important skill. The patient doesn't have transportation to outpatient appointments? Let the case manager work with the patient to arrange transportation options.

The time for case managers has come. And the technology needed to super charge their effectiveness is here.