Hospital Case Management
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Program Targeting Patients With Diabetes Reaches A1c Goals
West Virginia University's diabetes care program helped patients lower their A1c levels from an average of 10.25 to an average of 8.7 within three to six months. Even at 18-month follow-ups, 86% of patients recorded lower A1c levels than they did in the beginning, and one-third of patients registered A1c levels below 8. The team-based diabetes care program started as a quality improvement initiative.
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Not All Capitated Payment Models Work
Nearly a decade ago, Maryland experimented with a global budget payment model for rural hospitals. The plan was to give them a set amount of money, called Total Patient Revenue, to improve their efficiency. But it did not quite work out. ED visits dropped 12%, and non-ED admissions declined 23%. But there was little incentive for the hospitals to collaborate with community providers to improve patients’ health. Instead, the hospitals just reduced overall services.
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Health System Reaches ED Visit Reduction Goals by Focusing on Frequent Users
When a five-year, federally funded demonstration project began in New York, the goals were lofty: reduce preventable readmissions by 25% or more. NYU Langone Health achieved this goal through identifying frequent users and working with them through a targeted case management approach.
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Case Management’s Role in Managing Denials and Appeals in the New Healthcare Environment
Revenue is defined as the sum earned by the provider, measured in dollars. The revenue cycle is defined as the series of activities connecting the services rendered by a healthcare provider with the methods by which the provider receives compensation for those services. Case management plays an integral role in managing revenue and the revenue cycle in the denials and appeals processes. This month, we will discuss the case manager’s role in the revenue cycle as it relates to the management of denials and appeals.
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Nursing Innovation Is Underused and Can Be Leveraged for Career Advancement
Nurses are gaining more stature as potential leaders in healthcare, and much of the innovation in healthcare will come from nurses in the future. Hospitals should work to leverage the innovative potential of nurses, and nurses in the quality field should look for opportunities to advance their careers through this increasingly available pathway.
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Helping Patients Find Motivation to Make Changes
Eat healthy, exercise regularly, and sleep more are healthy goals case managers and nurses reinforce to patients. But case managers often have difficulty living up to their own advice when hectic daily schedules leave little time for healthy pursuits. These goals are so hard to pursue because the benefits are so long-term.
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Avoiding Denials for Transitions of Care
Too often, a patient’s claim for post-acute care is denied for reasons that are entirely preventable. This transition may include either rehabilitation or palliative services in a facility, ongoing outpatient therapy, or care provided at home. These authorizations are scrutinized closely by both payers and regulatory bodies, so it is critical that hospital case managers know how to avoid denials.
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Patient Activation Is a Health Promotion Method That Works
Case managers continually learn new methods to educate and engage patients. The key is to find the right method for case managers to achieve their patient education goals. The patient activation measure is based on the theory that there is a great deal of variation in patient activation/engagement in a patient population. Some patients need more support, and should be evaluated to see what works.
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The Inner Workings of a Health Coaching Program
Hospital case managers and others interested in extending case management through the use of student health coaches can implement a health coaching program with a local college. Both hospitals and colleges can benefit from the collaboration.
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Hospitals and Colleges Collaborate in Health Coach Training Programs
Some small-town hospitals and colleges have found a way to provide pre-med, nursing, and allied health undergraduate students with hands-on medical experience that benefits the community. The student health coaches perform case management-type services for at-risk patients. Called health coaches, these students learn skills years ahead of their peers. They receive college course credit and volunteer or internship experience. And, they contribute to positive health outcomes, including keeping patients out of hospitals and EDs.