Healthcare Case Management Program Article on Risk Management

Reducing risk to the patient and improving care is essential for any healthcare organization.  Providing the best care with the best risk management not only helps the patient but also protects the institution from future liabilities and helps the institution provide its mission to provide the best care.  It is because of this that risk management is an essential study and need within any organization.

It is important to manage risk in any healthcare setting. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “Why Healthcare Risk Management Is Important” by Caitlyn Cooley looks closer at the importance of risk management.  She states,

“Medical liability and reducing an organization’s risk against unseen threats has changed exceptionally since the start of the COVID-19 pandemic. We have seen new treatment centers, vaccines, and mass staffing problems across the United States. Risk management strategy “has traditionally focused on the important role of patient safety and the reduction of medical errors that jeopardize an organization’s ability to achieve its mission and protect against financial liability”, according to NEJM Catalyst. Unfortunately, these traditional risk mitigation techniques are not enough to combat cyberattacks on medical infrastructure.”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Case Management Program and see if it matches your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a career in Case Management.

Certified Case Manager Education: What is Population Health?

Population Health Management

Today’s Certified Case Manager is becoming more involved in assessing and working with information on population health. Population health looks at the data of an entire group instead of an individual patient and considers not only the general state of health of the population but typical outcomes as well.  “Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” (1)

 The term “population health” is a broad one and the group examined can be defined in a variety of ways; your chosen population could be a specific town or city, race or even age group. Viewing data across a broad population can help determine the best practices of care for that particular group and allow for that group’s needs to be anticipated and met. A definition of population health is: “The inherent value of a population health perspective is that it facilitates integration of knowledge across the many factors that influence health and health outcomes.” (1).    “The CDC, which has a Division of Population Health, is far wordier and gives more of a functional definition. Population health is interdisciplinary, according to the CDC website, and an approach that uses “nontraditional partnerships” among different sectors of the community — public health, industry, academia, healthcare, local government entities — to achieve positive health outcomes.” (2)  We see more content being added today to Case Manager Certification education curriculums on this interesting and important practice topic.

William Edwards Deming was a scientist and engineer and is best known for his principles of productivity; his approaches are often modeled by organizations looking to boost efficiency and quality while lowering costs. Deming’s involvement was a key component of Japan’s recovery after WWII; he also brought his unique take on the tie between quality and productivity to corporations in the US, including the Ford Motor company. This attention to quality helped Japan rebound after WWII and become a booming economy just a decade later; it also helped Ford and other US car makers understand why Japanese motors were outperforming homegrown products year after year. Applying these same principles to population health can help improve outcomes and as a natural byproduct of that improved care, reduce costs as well.

 

The Deming Philosophy and Healthcare

The Deming philosophy or approach at its most basic states that when an organization focuses on improving quality, costs will naturally fall over time. Case managers work with this philosophy everyday and are at the forefront of guiding quality, cost-effective care.  Conversely, an organization that is focused on costs will find their quality dwindling over time. This philosophy can be applied to a variety of industries – including healthcare. When we focus on improving care and outcomes, we can expect costs to drop; focus too much on costs and the quality of care can easily slip. Case managers know this well and serve as educators today to teach this to others on the health care team.

 

Applying Deming Principles to Healthcare

Managed Care = Managed Processes

The concept of managed care is less about planning the daily work of individual providers and more about the way that the entire process works. The broad approach that is taken to care will have a larger impact on the health of specific populations; engaging and including physicians and providers in the planning process is a must. These providers are the clinicians dealing with clients on a regular basis, and their insight could hold the key to improved overall process and better levels of care.

 

Engaging Physicians in the Process of Care

Including working physicians in the conversation will greatly improve both the approach to care and the outcomes. Doctors, nurses certified case managers and other providers are working “in the trenches” daily and already have the skills and knowledge to predict what methods will work and what will not. Incorporating frontline care providers in conversations about population health is a must if we are going to properly serve that population and understand what will work (and what won’t).

 

Accurate and Timely Data is a Must

“In God we trust…and all others must bring data.”
William Edwards Deming

This Deming quote is at the heart of why data is so important. If we can’t measure population health data, there is no way to tell if measures are resulting in improved outcomes, worsened outcomes or having no impact at all. The ability to measure and compare data from a specified population is a must; without accurate data and the ability to analyze it, there is no way to determine if measures designed to improve care have any actual impact at all.

The quality-based approach outlined by Deming offers many advantages and possibilities for population health and for healthcare in general.  For true gains to be made, the right data must be collected and accessible, front-line caregivers need to be involved in the planning process, and a broad approach to care for a specific population needs to be implemented. We need to continue to provide continuing education for our case managers and others on the health care team in the quality improvement process, including the use of quality improvement tools, data collection and appropriate interpretation of data.

Some reasons we should care about population health include; 1) it is people focused, 2) it seeks to improve the health of our society, 3) it helps to reduce costs as society becomes healthier, 4) it promotes medical science to deliver better care, 5) it leads to the ability to provide better access to care, and 6) it promotes better patient engagement (3). As such it fits very well into the role of todays certified case manager. It would be most advantageous if we provide our case managers more continuing education and opportunities to become involved in this area of practice. Becoming more intimately involved in population health will assist case management profession in its ultimate growth and expansion of specialized professional practice.

Are you a licensed health care professional who is interested in becoming a Certified Case Manager? If so, you may want to preview information on our Certification and Fellowship program at the American Academy of Case Management. You may access information here.

References:

  1. David A. Kingdig (Ed.) What is Population Health? Improving Population Health: Policy, Practice, Research. University of Wisconsin. Population Health Sciences.
  2. Karen Appold. Confused About Population Health? You’ve Come to the Right Place. Managed Healthcare Executive. Vol. 30, Issue 10. October 2020.
  3. Christina Rosario. Why is Population Health Important? Advanced Data Systems Corporation. July 8, 2020.

Case Management Certification Program Video

AIHCP and the American Academy of Case Management offers a four year certification in Case Management.  The program is online and independent study and open to qualified professionals in the healthcare fields.  The video below offers a more in-depth review of the program and some insight to what case management is and what it entails.

If you are interested, please review the Case Management Certification Program and see if it meets your academic and professional goals.

 

Please also review this video on AIHCP’s Case Management Program

Healthcare Case Management Certification Article on Value Based Care

Fee for service models are becoming less and less and value based care is taking over healthcare.  Providers need to supply better care and quality to patients.  They need to limit un-needed procedures and tests and instead focus on better care to reduce readmissions, decrease cost and improve patient health.  Payers are rewarding providers who supply better quality based care.

Value based care is important for not only the patient but also providers and payers. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “Value-Based Care Assessment: The First Step to Value-Based Care” by Emily Sokel looks closer at how to start implementation of such plans and models.  She states,

“Starting the transition from fee-for-service to value-based care is a challenge. Many provider organizations are simultaneously juggling new reimbursement models with old ones and breaking institutional memory to meaningfully move toward changes.  One hospital began its journey to value-based care with an organizational assessment. The value-based care assessment helps the hospital understand which value-based care contracts it is most prepared for and how to balance this transition with existing fee-for-service reimbursement, the director of case management told Insights during a recent anonymous discussion about the division’s latest findings.”

To read the entire article, please click here

Switching to a value based care model is important for providers as government payers and private payers demand more accountability for patient health and cost.  It is essential to increase the quality of care for all parties involved.

Please also review AIHCP’s Healthcare Case Management Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified healthcare professionals seeking a four year certification in Case Management

Case Management Program Article on Prolonged Stays in Hospital

One of the biggest problems in care is cost.  Long visits and efficient care increase any cost.  Sometimes hospital visits can become so long that cost is driven up immensely.  This may be sometimes necessary but in other cases, better coordination can prevent unneeded lengthy stays that increase cost and insurance issues.

Prolonged stays at hospitals albeit necessary can sometimes become issues cost wise. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “How a hospital becomes a costly hotel for patients who can’t leave” from UCDavis Health looks at patients caught in limbo of the healthcare system.  The article states,

“Extreme length of hospital stay – defined as 100 days or more – is not unusual at an academic medical center like UC Davis. A premature infant who requires intensive neonatal care to survive and thrive needs a lot of time in the hospital. The burn patient who needs specialized treatments, physical therapy and skin grafts often requires months of care, too. UC Davis Health has unique expertise for these types of lengthy, acute-care cases.”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management.

 

Case Management Program Article on Disparities in Cancer Care

Case Managers can play a key role in helping cancer patients with a variety of different issues discover proper routes in care and recovery.  Case Management is essential to collection of information and properly using that information for the overall benefit and health of the patient.  It is extremely important in the case of cancer cases.

Case Managers can play a key role in cancer recover. Please also review AIHCP’s Case Management Program

 

The article, “Health Disparities in Cancer Care” by Marissa Fors from Oncology Nursing News looks closer at issues that vary in quality of cancer care from one person to another.  The article states,

“Cancer patients face many obstacles to care, including financial, psychosocial, and practical barriers. Health disparities also prevent patients from receiving optimal treatment. In order to be an effective case manager, health care professionals must have a clear understanding of the definition of this role, the overall benefits of case management, and how to assess patients’ needs. The priority must be to put the patient first in order to improve outcomes. Addressing inequities in access to care is essential to adequately enhance a patient’s wellbeing.”

To read the entire article, please click

Please also review AIHCP’s Case Management Training Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management

Case Management Certification Article on Outcome Improvement and Revenue Recovery

Contact with patients is key to good case management.  Communication, updates and ensuring patients meet recovery requirements, as well as future preventative measures.  These things improve patient outcomes but also increases revenue for the facility.

Better patient outcomes is best for the patient but also the financial security of hospitals. Communication is key in ensuring better outcomes and regular recovery as well as preventative visits. Please also review AIHCP’s Case Management Certification

 

The article, “Closing Gaps in Care: Improving Patient Outcomes and Revenue Recovery” by Jaci Haack looks at three ways hospitals and other healthcare facilities can better engage patients and also increase revenue in the process.  She states,

“Encouraging patients to return to care sooner will not only ensure better outcomes but also ease the healthcare system back to normal. Given the magnitude of postponed care, this will hopefully quell a sudden wave of hospitalizations for newly diagnosed conditions that could overwhelm hospitals that may be facing another COVID-19 surge.”

To read the entire article, please click here

As society attempts to recover from the virus, it is important to engage patients to ensure quality care and prevention.  It is also important for healthcare to continue to grow financially so it can continue to offer services to patients.  Better Outcome Patient Management is key to this and communication is pivotal

Please also review AIHCP’s Case Management Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification as a Healthcare Case Manager.

Case Management Certification Article on Quality Care in Health

Quality improvement in any industry is important and healthcare is no exception.  If so, healthcare even carries a higher call for quality since it deals with human lives.  Case Managers can play a pivotal role in ensuring quality care at every phase of admission to follow up care.  Without good quality measures, outcomes would drop and most importantly quality of human life or even death can result.

 

Quality improvement in healthcare starts with admission and ends with follow up care to ensure the best outcomes. Please also review AIHCP’s Case Management Certification Program and see if it meets your needs.

 

The article, “What is Quality Improvement in Healthcare?” by Danielle Gagnon looks closer at quality care in healthcare and how to maintain and improve it.  He states,

“When healthcare leaders set goals for their organizations, such as preventing patient falls, or a medical system aims to lower opioid use after surgery, they use a process called quality improvement. But what is quality improvement in healthcare really about?”

To read the entire article, please click here

Please also review AIHCP’s Case Management Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management.

Case Management Considerations: When Should You Consider Hospice Care?

Terminally ill fatherBy: Dominick L. Flarey, Ph.D, RN-BC, MBA, ANP-BC, FACHE

Executive Director
The American Academy of Case Management

 

Case Managers today are on the front lines of palliative care and hospice care. Such models of care are complex and require the management of patients with very holistic health care needs including physical, emotional and spiritual. Patients and families often find that making choices about entering a hospice care program are very difficult and often times very frightening. They realize that the patient’s prognosis is poor and that they are entering the final stages of life. Patients and families are generally entering a time of Anticipatory grieving. So many questions regarding hospice exist especially related to the type of care and support services that will be provided to both the patient and the family. Case Managers are in an excellent position to be solid advocates and managers for facilitating this entire process and support high quality and cost effective outcomes in hospice care.

Very often, the first step in the process for patients’ and families is determining when hospice care should be considered. Good hospice care programs focus on relieving, rather than curing, a terminal patient’s physical symptoms. Hospice also provides support for patients as they cope with the emotional and social facets of dying. There are several situations in which patients and families may contemplate using hospice care. It is important that case managers educate patients and families on the total array of services that hospice care provides. Many have the misconception that hospice care is for pain control only. This is the farthest from the truth, of course. Here the case manager may play a critically important role providing more detail as to the many services and benefits that are available such as coordination of physician services and communications, RN home visits and pain control, the availability of nursing assistants in the home, grief counseling services, coordination of clergy visits and spiritual counseling, as well as insurance benefits consulting.

Often, your health care provider will refer you or your family member to a hospice program. He or she will typically make the suggestion when the patient has a life expectancy of fewer than six months. Hospice care frequently takes place in the terminal patient’s home, but in appropriate circumstances can also be offered at hospitals, nursing homes, and dedicated hospice centers. Here case manager’s work closely with insurance companies and government payers to insure that the patient meets the necessary criteria for hospice care and that the care will be covered appropriately under the patients plan. Case managers having education and expertise in managed care can also help insure that he patient is getting all of the available resources provided in their insurance plans.

If your health care provider does not mention hospice or if you initially refuse the option, you may find yourself considering it at a later stage. For example, terminal patients whose families are caring for them at home may worry that they have become burdens. At the same time, family members may experience “compassion fatigue” and need some respite in order to recharge their own batteries. Hospice volunteers can provide this respite in the patient’s home or in another care setting.

Respite care is a wonderful hospice benefit and case managers can be real advocates for families when respite care is critically needed for the family. Case managers by their education and training are able to assess the family’s status for the need for respite care or make arrangements for such assessments with behavioral health professionals.

In addition to offering palliative physical care, professional hospice workers act as an emotional support base for the dying person. Death does not have to be a traumatic experience, but the process usually brings up strong feelings, desires, and concerns. Hospice care helps terminal patients experience their emotions with honesty and courage. It also helps them face tough spiritual questions that may arise as the end of life nears.

Hospice also provides social support for patients with a limited life span. Loneliness, anxiety, and anger are all natural parts of the dying process. It helps to have experienced professionals who can provide a listening ear and practical advice for day-to-day coping. It also helps to connect with other terminal patients in support groups, counseling sessions, or recreational activities. Families often find that the hospice model of care was just as supportive and therapeutic for them as it was for the dying patient. Over many years I have personally been told by countless families of the wonderful support and experiences and “blessings” that hospice provided to them and their dying family member during their time of crisis and the patients passing. It is not uncommon to learn that a hospice nurse, a social work, a case manager, or several from the hospice team will attend the calling hours or funeral when the patient dies. Bonds are formed between the team, the patient and the families when working together in such a highly emotional environment and situation. This is just the nature of the hospice model of care.

Another incredible benefit of the hospice model of care is the on-going support to the families after the passing of the patient. Most hospice models of care provide for follow-up contact with the families on some type of on-going schedule and can provide them, as needed, referral services for grief counseling or other needed support services. Many hospices also provide an annual sponsored memorial service in which they invite families of their patients to come and join in a special service to memorialize all of their patients over the past year. As such, case managers can emphasize to families and the patients that there is continued support beyond the immediate care of the patient.

Hospice care may or may not be the right choice for you and your family. Most people find that at least some aspects of hospice care are greatly beneficial to helping manage the dying process. Before making a decision, discuss your options with your care provider and family members. Case managers play a critical role in hospice models of care today. They are educators, coordinators of care, and advocates for the patient and their families and can be very influential in assisting patients and families in better understanding the hospice model of care so that sound decisions about care in the final stage of life can be better made.

Interested Health Care Professionals who would like more information on our Case Management Continuing Education program, leading to Certification and Fellowship, may access information by clicking here.

Additional Resources

American Academy of Palliative and Hospice Medicine: Click Here

Creating an Effective Hospice Plan of Care: Click here

Is Hospice a Place Where One Goes to Die?: Click here

What is Hospice Care by The American Cancer Society: click here

Healthcare Manager Certification Article on Nursing and Adequate Supply

Supply is important for any hospital or healthcare department.  Supplies are critical for nurses to perform their duties and ensure patient health and safety.  With Covid, these supply lines have been challenged.  The importance of inventory is key to good Healthcare Management and keeping a department supplied is critical to success.

Keeping a department in healthcare supplied is key to patient health and nursing success. Please also review AIHCP’s Healthcare Manager Certification

 

The article, “How Hospital Supply Chains Impact Nurses, Patient Safety, and Margins”, from Managed Healthcare Executive Staff looks at some statistics and facts regarding supply needs and how it affects every aspect of care.  The article states,

“Nurses face significant supply chain management problems that impact efficiency, patient safety, and hospital margins, according to a recent survey from Syft, a leading national provider of healthcare inventory control and end-to-end supply chain cost management software and services.”

To read the entire article, please click here

Please also review AIHCP’s Healthcare Manager Certification.  The program is online and independent study and open to qualified professionals.  Also please review AIHCP’s Healthcare Case Management Program which is also online and independent study.  Both programs lead to four year certifications.