What's Holding Case Managers Back?
Data can be collected any time, place
Executive Summary
Technological innovations hold potential to make case management more efficient and higher quality, but reimbursement and regulatory barriers are slowing down the transformative change.
- Telehealth is rising in popularity, but case managers face barriers to assessing patient care when patients live in different states.
- Technology can help case managers communicate more effectively with clients and other healthcare professionals.
- Apps make it possible for case managers to find and recommend the ideal post-acute care unit for patients.
Case management and integration of technology at the end of 2015 is reminiscent of a mood setting in a Charles Dickens novel: The best of times, and…
It’s not that the technology hasn’t kept up with case management needs. It has. The problem is that the health industry’s reimbursement models and government regulations have not kept up with technology-driven case management.
Take telehealth, for example. The need and will are there, but problems remain with reimbursement barriers and cross-state health and behavioral health professional practice.
Video consult with physicians is expected to triple from 5.7 million in 2014 to 16 million by the end of this year, says Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, principal with EFS Supervision Strategies in Burke, VA. Fink-Samnick is co-author of a recent paper, titled, Case management practice: is technology helping or hindering practice?1
But even as video consults are increasing, there are obstacles to case managers using the technology to further their reach because of nurse and social worker licensing issues, she says.
“Case managers can do fabulous things for patients through telehealth and remote health,” she explains. “They can monitor various conditions; they can do medication reconciliation; they can look at symptom management.”
But as these same case managers begin to assess and intervene in patient care for patients who live in different states, they run risk of potential violations against their license, Fink-Samnick adds. (See story about the Nurse Licensure Compact in the October 2015 issue of Case Management Advisor.)
Technological innovations also make it extremely easy to collect real-time, accurate health data as patients carry on with their lives.
Fink-Samnick offers the following examples of how technology is at the cutting edge of transforming healthcare and case management:
- There are devices available that patients can use to send blood pressure and other information directly to their case managers and physicians.
- Digital chips attached to pills are swallowed and can send information that tells CMs or physicians whether patients have taken their medication on time and at the right dosage.
- Smart bras for women at risk of breast cancer can detect early signs of the disease.
- There’s an app for people with mood disorders that can send real-time data about when the patient can’t get out of bed or has a manic episode.
- Smart underwear for diabetic patients can monitor their health condition and glucose levels through a glucose sensor and biosensors, transmitting vital signs in real time.
- Ultra-thin electronic tattoo patches are laminated onto skin and monitor diabetics’ blood sugar levels or other patients’ vital signs.
“The Internet of things allows treatment providers tremendous ability to see how our patients are able to do in this moment in time,” Fink-Samnick says. “But what good is that data if you can’t actually access it?”
The problem isn’t in the collection of data; technology exists to collect data from just about anywhere a patient is. The problem is payment models and regulations that hinder the analysis and use of these data, she explains.
“Fifty million devices will be distributed to monitor patients’ health remotely over the next five years, and, again, that’s great,” she adds. “But we have got to be able to use that data accurately, and we have to assess it — which gets to the licensure issue, and people have to be reimbursed for it.”
Through technology, case managers and health organizations can better manage care for patient populations, says Marjorie Green, MS, president of Healthcare Excellence Institute in Phoenix.
For instance, technology can be used to reinforce the behavior changes necessary to improve care for people with chronic illnesses, she says.
“If you look at Medicare, two-thirds of spending is for people with five or more chronic conditions, and most of these are behaviorally based,” Green says. “What works with changing behaviors is it really doesn’t have to do with things like education and the doctor telling you to stop smoking or stop doing this or that.”
Technology that provides real-time data with the potential of case management and reminders to patients of the desired behavior could be the answer.
“Most of healthcare leads with the clinician trying to change the individual first and the behavior will follow, but we know that doesn’t work,” she explains. “Instead, change the behavior first and the mind will follow.”
The way it works is an electronic app can accelerate behavior change through immediate reinforcement. For instance, the app could track a diabetic patient’s blood sugar levels or weight and send information to the case manager. If the patient’s data shows a problem, the case manager can intervene, Green says.
Another use of technology is to combine it with social support to help people change their behaviors. The app makes it possible for case managers to tap into invisible resources — families, friends, and others who can provide peer support and a health-conscious environment, she adds.
“When you look at invisible resources, you see these families and friends are undervalued significantly,” Green explains. “I talk with case managers who are down in the trenches, realizing that they’re sending this person home when the person has no support and is doomed to fail, but there are no other options.”
A technological innovation that draws on invisible resources and social support could be an easy solution. Case managers can use technology to help patients tap into this invisible — and free — resource to help patients, she adds.
Also, the app can provide social support by making it possible for the patient’s social network to provide immediate help when necessary. So if the patient needs a ride somewhere, the app will notify members of the patient’s social support group and find someone who can give the patient a ride, Green explains.
Using apps to reinforce social support adds a service layer to case management, she notes.
Based on this app and its connection to patients’ social support groups, case managers can rate patients according to their risk profile. Those who have greater support networks would have a lower risk profile and need less case management attention. Those with fewer people in their social network might need more phone calls or visits from a case manager, she adds.
The key is tying technology to a service model because technology without the service model likely won’t overcome case management obstacles, Green says.
Other technological advances involving applications and the use of computers and smartphones focus on improving communication between case managers, physicians, and other healthcare providers, says Bonnie M. Geld, MSW, vice president of The Center for Case Management Inc. of Wellesley, MA.
Such technology can help case managers keep track of where their patients access health care throughout the care continuum, Geld adds.
“It’s really important to know where the patient is at any given time,” she explains. “If the patient goes to post-acute, the community case manager could be tagged by the hospital case manager, who says, ‘Your patient went to ABC facility and should be there 20 days.’”
Technology can make bidirectional communication more efficient, particularly when health systems need to communicate with case managers and providers in the ambulatory setting, Geld says.
Even with some of the latest electronic medical record technology, this type of communication has not been a priority, Geld notes.
“So we’re recommending a common document that’s called case management or social worker, and it’s in a common platform where every case manager within a health system — whether inpatient or outpatient or payer based — can easily access notes from anywhere the patient has been,” Geld says.
Health systems and some cities are starting to create common portals that hold specific health information that could be accessed about any patient at any health provider location, Geld adds.
“People are starting to do this, which is really exciting,” she says. “In Minneapolis, the whole city was creating a cloud with five pieces of information about the patient, maybe immunization, records, medications, psychosocial information that you could access anywhere.” (For more information on the system, visit http://yhoo.it/1LtcBGm.)
Another technological advance in communication is a program that helps providers, case managers, and patients find the right post-acute care facilities to manage a particular patient’s care, Geld says.
“We still have to give patients’ choice, but we can give them more educated choice,” she says. “If I’m a hospital case manager and I’m working on a search for a patient, I can go to [this app] and select the facilities that will best meet my patients’ needs clinically.”
It starts with a conversation with the patient and family about what they want in a post-acute care provider. With this information, the case manager develops a search list for the patient. The program also keeps the case manager informed of the patient’s location for a follow-up call, Geld says. “It will keep up with the patient across the continuum.”
REFERENCE
- Fink-Samnick E, Muller LS. Case management practice: is technology helping or hindering practice? Prof Case Manag. 2015;20(2):98-102.
Reimbursement and regulatory barriers are slowing down the transformative change that technology makes possible.
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