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Document outcomes to prove your value
Tallying soft savings is not enough anymore
Today's case managers need to understand outcomes and track them in order to prove that their interventions have value, says Mary Jane McKendry, RN, CCM, MBA, director of education, training, and consulting for McKesson and president-elect of the Case Management Society of New England in Hampstead, NH.
"Case management is at a crossroads. We know that case management brings something valuable to the table, but now we need to clearly define the ways to accurately measure the results of our interventions and design a way to report on it," she says.
McKendry is a member of the Case Management Leadership Coalition (CMLC, on the web at www.cmleaders.org), a group of leaders representing a broad cross-section of the case management field. The CMLC was formed to address the challenges facing case managers in a changing health care environment. McKendry is on the CMLC task force researching quality and outcomes reporting metrics and return-on-investment tools and strategies.
Simply put, outcomes are the end result of the interventions a case manager performs, McKendry says.
In the past, case managers have faced challenges in documenting their interventions because they often lacked the appropriate software, there were no processes in place to document outcomes, and there were no hard-and-fast rules about what to document.
McKendry recalls that in a previous job, she was able to call as many as three clients in a 15-minute period and make good decisions and suggestions about the clients' care, but it would take an hour or longer to document the discussions.
Most case managers who document their outcomes have had to learn how to do it by the seat of their pants, she adds.
Some case managers have been doing cost/ benefit analyses and documenting soft savings, but many people haven't paid attention to this because it hasn't been hard dollars, she says.
The challenge is how to take global case management strategies such as assessment, planning, implementation, and evaluation, and build models that work for organizations to track which case management interventions are done, which outcomes should be observed, and how to report on them, McKendry says.
"Chances are that we document only the most critical interventions. We are making interventions we can't quantify or not documenting what we are doing," she says.
It is critical for case management departments to be able to take what a typical case manager does and link it to cost savings or good outcomes, she adds. The information has to be in a form that can be used to generate a report that documents the related savings.
"It happens every day. The patient has a concern. The case manager discusses it and directs them to the right care, helping them avoid an emergency room visit or exacerbating their condition so much that he or she needs to be hospitalized. These are important interventions, and we have not done a good job of documenting them, or we document them in a narrative form," McKendry says.
McKendry suggests that case management directors collaborate with their information technology staff to create a way to measure outcomes and quantify the impact of interventions. Some case management departments have used an off-the-shelf spreadsheet program to track their interventions, she adds.
If your computer technology isn't sophisticated enough, create a paper worksheet that case managers can use to jot down their interventions. The information can be put into the organization's data warehouse, she says.
Start by listing the typical interventions that case managers perform in a way that makes it easy for the case managers to check them off. With a software application, there can be a screen with places for the case managers to check off what they did.
Even with paper copies, it's easier to document in an outline format than in a narrative form. Outlines also make it easier to generate reports later on, she adds.
Every time a case manager does something for a patient, he or she should fill in the data and transmit them to wherever your data are stored.
Come up with a way to measure how a case manager's interventions have an impact on the quality of life, clinical, and financial aspects of care.
Link what you do to those three markers: Clinically, the patient is doing what he or she needs to do and knows where to get help. The patient's quality of life is better because he or she feels better. The company is financially better off because the patient requires less urgent care and fewer visits to the physician's office.
"Case managers have to be able to define in some kind of format the things they do, when they do them, and the impact they have. It's not just that they make calls, it's what they learn when they call and what they then do with the information," she adds.
For instance, if you call patients with congestive heart failure to check on their weight, be able to document that if the patient gained weight, you helped the patient get in to see his or her physician. Then you could include in your report that you helped the patient avoid a potential admission.