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In this month's issue of Case Management Insider, we will continue our discussion on case management roles, functions, and models, with more information on today's best practice models. We will explore the advantages of each model and minimum staffing ratios for each.
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Since the Presbyterian Healthcare Services in Albuquerque, NM, started its emergency department navigation program, targeting patients who seek treatment for minor ailments, 11,600 patients have been navigated to other levels of care. Only about 5% of them have returned to the emergency department with non-emergent conditions or illnesses.
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When St. Anthony's Hospital and Pinellas Point Nursing and Rehabilitation, both located in St. Petersburg, FL, collaborated on a project to reduce heart failure readmissions, the team determined that many readmissions were for sepsis. They embarked on a project that eliminated sepsis as a reason for readmission in just six months.
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One of the ways busy EDs are attempting to manage long wait times is by enabling patients who don't need immediate care to make an appointment to be seen in the ED one or two hours in advance.
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As part of its efforts to reduce readmissions, WellStar Health System, based in suburban Atlanta, is meeting with post-acute providers to collaborate on ways to make transitions between levels of care smoother. It is piloting a program in which a transition coach works with heart failure patients in the hospital and follows them for four weeks following discharge.
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Case management follows a process, not unlike the clinical nursing process or social work process. By following a process, case managers can function more effectively and efficiently.
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With the increase in uninsured and underinsured patients, hospitals face the challenge of finding post-acute care for unfunded or underfunded patients, or keeping them in a bed when they no longer need the acute level of care.
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In its efforts to ensure that the uninsured and homeless receive the healthcare services they need, Carondelet Health Network in Tucson, AZ, has developed a list of community resources and partnered with community agencies to provide care for patients underserved patients.
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In order to provide consistent post-acute care for uninsured or under insured patients, hospitals need to think like payers and develop a payment assistance policy so that at admission or registration, a financial counselor can do a quick assessment and determine who qualifies and who doesn't, according to Matt Boettcher, LSW, MSW, vice president for continuum of care for Scott and White Healthcare, with headquarters in Temple, TX, and consultant for the Center for Case Management, a patient care management consulting firm based in Wellesley, MA.
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At Montefiore Medical Center in the Bronx, NY, a complex care case manager coordinates appropriate post-discharge options for uninsured and under-insured patients who are likely to need complex care after discharge.
