Case Management Boot Camp: Strategies for Success in the Acute Care Setting and Beyond!

We can’t fully understand case management without a brief look at the history of health care access in the 20th century, The development of the health care insurance, healthcare as a benefit and the introduction of Medicare and Medicaid. Case management developed from utilization review and quality assurance changing it’s name and focus 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. We will see how the Affordable Care Act broadened the practice making it essential to the viability of the industry.Included will be a review of Medicare’s latest programs that impact on 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. We will also touch on staffing models and caseload calculation.

Utilization management was the first role applied in acute care case management models. It was first known of 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 and for denials management with tips and strategies for stream-lining the process and promoting efficiency.

Discharge planning is a limiting term applying only to movement from the hospital to the next level of care. Transition planning is the 21st century version encompassing the full continuum of care, It is a “process” that starts at the point of encounter in or outpatient and follows the patient through their healthcare journey. 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. Transition 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.

As case managers we must be aware of the myriad of compliance issues that we must adhere to in our daily practice. Never has this been more important to our work as case managers than it is now. This program will review the compliance issues that most greatly impact on your practice such as the 2-midnight rule, the NOTICE Act, HINNs, the Conditions of Participation, and many others. The Joint Commission and other hospital accrediting bodies are now monitoring these issues when they have deemed status from Medicare, so your compliance is critical to a good hospital survey outcome. This module will help you to identify where you may have compliance practice gaps as well as how to fix them!

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? We will discuss the use of metrics vs anecdotal information. 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.