Hospitals — some more slowly than others — are moving from the traditionally reactive to newer proactive model of providing quality healthcare. This puts case managers in the driver’s seat when it comes to steering the organization to better outcomes.
“Healthcare costs are high, and we want to try to reduce costs for patients while maintaining quality care,” says Lisa Morrison, MSN, RN, CCM, regional case manager of Signature Care Management with Signature Medical Group in St. Louis.
“Quality is incorporated into the whole process,” she says. “I’ve been a nurse and case manager for more than 25 years — I’ve seen this whole shift from being more reactive to being more proactive in care, and it has changed healthcare costs. That’s where value-based care really shines.”
In Morrison’s early nursing days, the focus was on fixing the patient’s health problems. If a patient had heart disease, case management and nursing care helped the patient recover and return home. Now, under a preventive care model, nurses and case managers help patients stay healthy, follow heart-healthy diets, take medication, and do what they can to prevent heart disease, Morrison explains.
“It’s nice to see that nurses and case managers have become more proactive in the way healthcare is delivered,” she adds.
As hospitals make this shift to proactive care, here are some of the ways case managers can help organizations successfully navigate the new paradigm:
• Become the communication point person. “They can advocate for the patient and talk to all providers involved in the case,” Morrison says. “Whether they’re working with the physician, post-acute care facility, or home health agency, the case manager takes ownership as the point person.”
This requires strong communication skills and the ability to speak in a way that everyone can understand, including patients, physicians, and post-acute providers.
“Case managers basically guide and assist in that post-acute care setting, adhering to physician orders,” Morrison says.
Communication can include phone calls, face-to-face conversations, educational pamphlets, text messages, and emails, she notes.
“Case managers can be the communication hub,” she says. “They now are being incorporated into physician practices, and those case managers work one-on-one with hospital case managers and discharge planners to streamline the patient’s process of moving through the continuum of care.”
• Set expectations for a value-based care environment. In today’s value-based care world, case managers need to help patients set expectations as early in their hospital visit as is possible, Morrison suggests.
For example, when case managers are working with patients undergoing surgery, the goal is to explain how they will be heading home after the surgery and not necessarily be admitted to inpatient rehabilitation services, she says.
“If there’s a caregiver at home and the patient doesn’t have many comorbid conditions and has stable health, then the discharge expectation destination could be going home instead of utilizing post-acute care, which can be very costly and drive up healthcare costs,” Morrison says. “You might set that destination expectation on day one.”
Tell patients what might happen. Emphasize that they will see better outcomes at home and could still receive home health services or outpatient therapy services as needed, she adds.
It is very important for case managers to help patients understand what to expect post-surgery and to help them prepare for all necessary self-care. Case managers also might ensure patients’ social networks are stable and someone will be at home with them in the first few days post-surgery.
“Case managers look at all aspects of the patient to optimize them to the fullest potential and to set expectations for the patient going home,” Morrison says.
The goal also is to discuss these expectations with patients’ caregivers while educating them about how to help patients recover health and movement and avoid rehospitalization.
“Having educational training sessions with the family can be very helpful,” she says.
• Align care across all provider areas. In a value-based world, case managers are team players. They might round with physicians. They meet with patients face-to-face early in the hospital stay, and they follow up near the end of the stay, Morrison says.
“They engage with physicians and align care, informing patients, families, and all other providers of what the care plan is and what the physician’s expectations are,” she explains.
“Case managers can help empower and educate physician staff about being part of the team,” she adds. “It gives a certain credibility to your role as case manager; it helps build trust.”
Aligning care entails having providers share a vision for the patient’s care and goals and how to integrate their services into that care, she says.
• Learn more, continuously. “We can continually educate ourselves,” Morrison says. “Knowledge doesn’t stop when you get your degree or certification. Knowledge is continuous; continuous growth and continuous education is key.”
Case managers might also learn best practices in educating patients. “It’s vital you make sure you are consistent in your messaging to patients,” Morrison says.
“Don’t give patients mixed messages because that will set up the patient for failure,” she explains. “Be genuine. I know it sounds cliché, but I think all nurses are very compassionate people, and we all want to make sure that patients are doing their best. When a nurse builds trust, it feeds into their credibility.”
It also is important that case managers advocate for the shift to value-based, proactive care as a positive trend for all healthcare providers.
“I’m so passionate about case management because I’ve seen it from the very infancy to where it is now, and it’s just phenomenal to be a part of it,” Morrison says. “It makes me proud to be a nurse and case manager.”