Involve primary care docs in your CM efforts

Team approach better than individual interventions

Managing the care of patients should be a partnership between the case manager and the primary care physician, Ellen Aliberti, BSN, PHN, MS, CCM, says.

"When the primary care physician is involved in care management, the care managers can do a better job of managing the patient care and the resources," says Aliberti, regional director of care management for HealthCare Partners in Pasadena, CA, one of the largest medical groups in southern California.

HealthCare Partners’ care management umbrella includes utilization management, quality improvement, and case management.

The primary care physician takes the lead role in directing patients to specialty referrals and managing acute care stays.

Because the primary care physicians are the first members of the health care team to deal with patients, Aliberti advocates educating them about the types of populations your case management program targets and suggesting early interventions they can take to manage the patients.

"Care managers have got to get doctors involved. The doctor is the clinical expert, and that’s why their participation on the interdisciplinary team is so important. If we recognize that the primary care physician is the key to the care management team and arm them with interventions and insights into the population, we may, as a team, be able to manage more patients and do it proactively before their problems get out of control," she adds.

Remember that physicians have their patients’ best interest in mind, she adds.

"Care managers sometimes think that doctors are just obstacles to saving money, but what they are doing is advocating for their patients. We can’t ignore them. We need to embrace them and ask them for help in managing the patients, recognizing their knowledge base and that the patient-physician relationship is so critical to the success of patient care," she adds.

Make sure you keep the primary care physician in the loop, Aliberti adds.

Great reports and great documentation don’t matter if you don’t share them with the primary care physician. Physicians have to sign care plans for home health, but they don’t have to sign off on case management.

"It’s important to enhance communication with the physicians and involve them in interventions. Nobody does that enough," she says.

Aliberti recommends incentives to physicians who are resistant to participating in the case management team process. For instance, you might ask them which five patients give them the most problems and offer to help with those patients.

"You can have care management do an assessment on those patients, put a care plan together, and work with the physicians on how to implement it. Hopefully, you’ll have a positive outcome, and the physicians will buy into the care management concept," she says.