The Role of Artificial Intelligence in Hospital Case Management

Why Should You Attend:

With AI being utilization more and more in healthcare and well-introduced into acute care case management, it is time for hospital case management leaders and staff to become familiar with this process. Through familiarity, the opportunity to investigate the possible use of an AI process can be reviewed by department leaders and staff.

Hospital executives and IT leaders are welcoming such support to their staff and this could be a remarkably interesting concept to introduce to your leadership executive.

This webinar will provide an introduction to AI in healthcare, in hospitals and in the hospital case management department. A structure for use will also be introduced. Be inquisitive in the future of IT in your department and this innovative process to enhance your staff and move them to best-practice operations. Just a reminder—AI does not replace all your staff; it only enhances your staff.

As hospital case management departments have evolved, it is not unusual to find that the vast majority of departments are not able to fill all of their positions. As a result, both RN case managers and social work case managers are working with a higher than optimal patient load. With this increased patient load, they cannot maintain a sense of urgency during their day—they are just struggling to get through what they feel are their priority areas.

AI has been able to take some of the tasks that RN case managers perform in the utilization management role and mimic these human functions, or smart tasks, through “learning” the tasks in an algorithmic format in the medical record. AI bringing an entire paradigm shift to healthcare, powered by increasing availability of healthcare data and rapid progress of analytics techniques. Popular AI UM techniques include machine learning methods of data that an RN case manager would review during a first level medical necessity review.

Naturally, there is unease and concern with this sort of “outsourcing” part of the UM process to a computer, but there has been well-studied use of the AI process in UM, showing success. In no way will AI take over the role of the RN case manager in utilization management, but it can be a significant enhancement to the process.

This webinar will review the history of AI, the current use in hospitals for both UM and discharge planning. It will also review the pros and cons, leaving the attendee with great information to consider the possible use of AI in their case management program.

Areas Covered in the Webinar:

• AI: History
• AI: Transition to Healthcare
• AI: Case Management
• Challenges in Hospital Case Management Lending the UM Process to An AI Initiative
• The Pros
• Automation of A Highly Manual Process
• Subjectivity in The UM Process
• Challenges of High Patient Loads and Ensuring Appropriate Prioritization
• Value of AI in A Hospital Case Management Department
• AI And the Denial Process
• The Cons
• The Computer Might Replace the RN UM Role
• Having the Technology
• Being Able to Explain AI to Your Executive
• Staff Buy-In
• Alignment with It
• Discharge Planning: Is There A Role for AI in This Role?
• Making the Decision
• Putting A Plan in Place—Whether It Is Yes or No
• Evaluating Your Decision
• Artificial Intelligence or Augmented Intelligence?

Who Will Benefit:

• RN case managers
• Case management leaders
• Social workers
• Physician advisors
• Executives responsible for case management
• IT leaders responsible for collaboration with case management
• Hospital case management departments

Bev Cunningham
Consultant, Case Management Concepts LLC

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

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