Case management began moving into acute care settings around 1985 following the introduction of prospective payment. Today case management is found across the continuum of care, most recently returning to the community where its roots began. This module will review where case management came from and how it will work in today’s managed care and government payer environments. Included will be a review of Medicare’s latest programs that impact the role of the case manager most directly including value-based purchasing, the readmission reduction program, accountable care organizations, and others. Take a glimpse into the future in this state-of-the-art review.
The role of the case manager and social worker is dynamic and constantly changing in response to the changes in health care delivery and reimbursement at the federal, state, and local levels. While change remains a constant, there are certain core roles and functions that apply to the work of the social worker and nurse case manager regardless of job setting. In addition, case managers and social workers work within guidelines that provide us with definitions of practice, guiding principles, and philosophy statements. This module will include these issues plus a description of the best practice case management models and how the roles of RNs and social workers can be developed to meet the outcomes of a hospital in the era of value-based purchasing. Also included are the best practice staffing ratios based on model selection.
Utilization management was the first role applied in acute care case management models. It was first known as utilization review but has evolved into something much more comprehensive than that. Today it encompasses elements of resource management and denials management as well. This module will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice with tips and strategies for streamlining the process and making it as efficient as it can be.
Discharge planning has become more than just the movement of the patient out of the hospital. It is a “process” that starts at the point of admission and follow beyond discharge. The Centers for Medicare and Medicaid Services have recently added more “teeth” to the process. This module will review the most recent changes from the Medicare program as well as strategies for safely transitioning your patients across the continuum of care. In addition, we will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. Transitional planning is no longer a destination but a process! Learn how to be sure that your processes address the complexities of the new healthcare environment.
When all is said and done, how do we know that we are doing a good job as case managers? How do we know what our impact is on our patients and on the organization? This module will discuss the latest ways in which case management departments and staff can ensure that they are achieving the outcomes that they hope to achieve. Included will be what the latest outcomes measures are in the field of case management as well as examples of dashboards that you can create to track and trend your results over time.