Primary care can lower higher healthcare prices by diagnosing potential problems before they become acute. Regular primary care visits and checkups can perform the preventative measures that can help a person distinguish between healthy and unhealthy choices. Regular blood work and physical checkups can spot early issues that can lead to more expensive treatments later. Primary care can play a large role in better health and less cost.
Regular checkups with a primary physician can lower healthcare costs. Please also review AIHCP’s Healthcare Case Management Certification
The article, “How Primary Care Can Help Lower Healthcare Costs” from UniCare State Indemnity Plan,Brand Partner, looks more closer how primary care can play a key role in lowering healthcare costs. The article states,
“Whole health is not only about your physical health, but the behavioral, emotional, and social factors that affect your overall well-being. Non-clinical factors like access to nutritious food and reliable transportation, personal finances, and social isolation can determine up to 80 percent of health outcomes. Primary care physicians (PCPs) are well positioned to help their patients better understand and manage such drivers of health – think of them as the quarterbacks of healthcare.”
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 professionals seeking a four year certification in Healthcare Case Management.
An important aspect of healthcare case management is post acute care. Post acute care is important because it follows the care and follow ups needed after a hospital admission. This is pivotal in lowered hospital readmissions that would not be necessary if better follow up care was provided. Working with post acute care providers is essential to ensure better quality care for the patient over the long term. Healthcare Case Managers play a key role in coordinating care after illness and during recovery to ensure the proper follow-up care is fulfilled and met. They arrange and help the patient find the proper facility to meet their recovery needs as well as help the patient receive the proper follow up treatment.
Post Acute Care is important for long term health of patient. Please also review AIHCP’s Healthcare Case Management Certification
The article, “5 keys to effective post-acute care management” by Page Minmyer looks closer at better post acute care practices. She states,
“Effective post-acute care management requires a multidimensional approach that incorporates effective communication, data analytics and clearly defined care coordination roles, according to a new white paper from Leavitt Partners. The benefits, however, are clear, as better post-acute care management can reduce readmissions, allow providers to more easily manage length of stay in skilled nursing facilities and better monitor discharge.”
“5 keys to effective post-acute care management”. Paige Minemyer. Fierce Healthcare. May 4, 2017
The field of healthcare case management is concerned with the coordination and delivery of care to patients with chronic or complex health conditions. Case managers work with patients and their families to develop a plan of care that meets the unique needs of each individual. They also work with other members of the healthcare team to ensure that all aspects of the patient’s care are considered and that care is delivered in a coordinated fashion. This process can help to improve patient outcomes by making sure that the care they receive is timely and appropriate. Additionally, healthcare case management can help to reduce the overall cost of care by preventing duplicate services and avoiding unnecessary hospitalizations.
Post Acute Care
In regards to post acute care, the process is even more important in reducing readmissions. Post-acute care is a type of medical care that is provided to patients who have been discharged from the hospital but still require some level of medical care. This type of care can be provided in a variety of settings, such as skilled nursing facilities, home health agencies, or inpatient rehabilitation facilities. Post-acute care is to help patients recover from their illness or injury and return to their prior level of functioning. The goal of PAC is to help patients transition from the hospital to their homes or another care facility, such as a nursing home. PAC typically includes a variety of services, such as skilled nursing care, physical therapy, and occupational therapy.
Care managers also ensure the patient finds the proper facilities. Post acute care facilities provide medical and rehabilitative care to patients who have been discharged from the hospital but still require close medical supervision. These facilities typically offer a wide range of services, including skilled nursing care, physical therapy, speech therapy, and occupational therapy. patients in post acute care facilities often have complex medical needs that require close monitoring and coordination of care.
Types of Post Acute Care
Post Occupation Therapy is the process of helping people return to their previous level of functioning after an injury or illness. This can involve helping them regain their strength and mobility, as well as their cognitive and emotional well-being. Quite similar is physical therapy. Post-acute care physical therapy is a type of PT that is focused on helping patients recover from a serious injury or illness. This type of PT can involve working with patients who are in the hospital, as well as those who have been discharged and are receiving outpatient care. The goal of post-acute care physical therapy is to help patients regain their strength, mobility, and independence.
Through these therapies, checkups, and follow ups, patients can find the acute care they need after their initial stay in the hospital. Care Managers can arrange and help the patient find the proper facilities or therapies for their particular needs and also work with the insurance companies in paying for this type of necessary care. In the meantime, these type of post acute cares can prevent relapse or costly readmissions into the hospital.
Conclusion
In conclusion, case management is a vital role in the health care industry. Without case managers, patients would not receive the proper care and attention they need. Case managers are there to help patients every step of the way, from diagnosis to treatment and beyond. If you or a loved one is in need of health care, be sure to ask for a case manager. They can make all the difference in getting the care you need. In regards to post acute care, case managers play a vital role in coordinating post-acute care. They are the link between hospitals, patients, and families during a time that is often filled with uncertainty. By educating themselves on the different types of post-acute care options and communicating effectively with all parties involved, case managers can ensure that patients receive the care they need to recover successfully.
Please also review AIHCP’s Healthcare Case Management Certification and see if it matches your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Healthcare Case Management. Nurses and other healthcare professionals are excellent candidates to take the required courses and become eligible for the certification.
Additional Resources
“Effectiveness of Multidisciplinary Rehabilitation Services in Postacute Care: State-of-the-Science. A Review”. Janet A.Prvu, et, al. Archives of Physical Medicine and Rehabilitation Volume 88, Issue 11, November 2007, Pages 1526-1534. Access here
“Postacute Care Preparedness for COVID-19Thinking Ahead”. David C. Grabowski, PhD, et.al. JAMA. 2020;323(20):2007-2008. doi:10.1001/jama.2020.4686. Access here
“Successful Management of Post-Acute Levels of Care”. Rebekah A. Koutny, RN, BSN, CCM, MCG Nurse Editor, and Carrie Brockman, BSN, RN, ACM, MCG Senior Nurse Editor. MCG Community. Access here
“Post-acute Care for People with Cancer”. American Cancer Society. Access here
Telehealth is here to stay. While it was necessary during the pandemic and any future elements of it that may linger, the benefits of telehealth has found a more permanent place in modern medicine. It will continue to play a large role in medical care. It will also play a large role in affecting the Case Management and how patients meet recovery requirements. It may be easier to keep tabs on patients and ensure they are following protocol through telehealth check ups that require less time. A simple appointment of follow up care can be an easier way to manage patient care following procedure.
Telehealth has many benefits. In particular, there are many benefits to better case management since telehealth can promote better follow up care and patient accountability. Please also review AIHCP’s Healthcare Case Management Program
The article, “8 benefits of Telehealth” by Siemens Healthineers looks at the benefits of telehealth. The article discusses 8 pertinent benefits of telehealth to healthcare. Among the many are better patient outcomes which is essential in case management. The flexibility, adherence of the patient and cost reduction all play key roles into cheaper healthcare in the future as well as better case management. It is believed that telehealth is here to stay after the pandemic and that is a good thing. The article states,
“The benefits of telehealth are striking, offering hospitals the chance to brand themselves as innovative and using cutting-edge technologically. And while the pandemic has pushed telehealth forward, its ability to provide a high level of medical care in numerous situations will make telehealth a permanent fixture in healthcare. Continuous improvements in technology and further simplifications of tedious processes support this evolution.”
“8 benefits of Telehealth”. Siemens Healthineers. February 15th, 2022. Healthcare ITnews.
Telehealth is an important tool for healthcare providers. It allows providers to connect with patients remotely, using technology such as video conferencing and phone calls. This can be beneficial for both parties: providers can save time and money on travel, and patients can avoid having to take time off work or find childcare. In addition, telehealth can be used to provide care to patients in rural areas who might not otherwise have access to healthcare.
There are many advantages of telehealth, which is why this mode of delivery is becoming increasingly popular. First, telehealth can improve access to care by providing services to patients in rural or underserved areas. Second, it can increase convenience and decrease wait times for appointments. Third, it can improve continuity of care by allowing providers to more easily follow up with patients after they leave the office. Fourth, it can reduce costs by reducing the need for travel and office visits.
Case Management and Telehealth
Case management is a process of coordinating care for patients with chronic conditions. Due to this, telehealth can help case managers. This can include real-time interactive services such as live video conferencing, as well as asynchronous services such as store-and-forward imaging. Telehealth is often used to support remote patient monitoring, provide consultative services, or deliver continuing medical education.
There is evidence that suggests that case managers using telehealth can be just as effective as traditional in-person case management, if not more so. A study published in the Journal of Case Management found that patients who received care from a case manager via telehealth had better outcomes than those who received in-person case management. The study found that patients in the telehealth group were more likely to receive preventive care services and to have their chronic diseases managed effectively. Case managers using telehealth can provide their clients with real-time access to medical specialists for consultation, education, and treatment. This delivery model can also be used to facilitate care coordination between providers, which is essential for optimizing patient outcomes.
Telehealth truly helps case managers with better patient outcomes. There is a growing body of evidence that supports the use of telehealth in a variety of settings and for a variety of purposes. Studies have shown that telehealth can lead to improved patient outcomes, including increased satisfaction with care, improved compliance with treatment plans, and reduced hospital readmission rates. While more research is needed to determine the best ways to leverage telehealth technology to achieve optimal results, the existing evidence suggests that telehealth is a promising tool for improving patient care.
Conclusion
In conclusion, telehealth has the potential to improve case management by providing real-time access to data and patient status, as well as facilitating communication between care team members. With these improvements, telehealth has the potential to improve care coordination and patient outcomes. It is clear that telehealth has many benefits that can lead to better patient outcomes. These benefits include increased access to care, improved communication between patients and providers, and lower costs. Telehealth can also help to reduce the spread of infectious diseases. As more and more people use telehealth services, it is likely that these benefits will continue to increase.
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. After completing the required courses, qualified professionals can then apply for the four year certification.
With the emergence of telehealth, case management will profoundly change in the 21st Century and many nurses can take advantage of this exciting field by becoming certified through AIHCP.
Additional Resources
“What Is Telehealth?”. NEJM Catalyst. February 21st, 2018. NEJM: Innovations in Care Delivery. Access here
“Using Telehealth to Deliver Nursing Case Management Services to HIV/AIDS Clients”. Jennifer Lillibridge, RN, PhD, etc. al. November 26th, 2008. The Online Journal of Issues in Nursing. Access here
“Exploring the Benefits of Telehealth Case Management”. Renato Parletta. October 14th, 2022. Insight. Access here
“Telehealth and Telemedicine”. CDC. July 8th, 2020. CDC. Access here
“Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews [Internet]”. Annette Totten, etc, al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jun. Report No.: 16-EHC034-EF. AHRQ Comparative Effectiveness Technical Briefs. Access here
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.”
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.
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:
David A. Kingdig (Ed.) What is Population Health? Improving Population Health: Policy, Practice, Research. University of Wisconsin. Population Health Sciences.
Karen Appold. Confused About Population Health? You’ve Come to the Right Place. Managed Healthcare Executive. Vol. 30, Issue 10. October 2020.
Christina Rosario. Why is Population Health Important? Advanced Data Systems Corporation. July 8, 2020.
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.
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.”
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
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.”
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 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
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.”
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.
