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When multiple case managers are working with a single patient, the case manager who controls the dollars ultimately coordinates the care, asserts Anne Llewellyn, RNC, BHSA, CCM, CRRN, CEAC, an independent case manager in private practice and founding partner of Professional Resources in Management Education Inc.
"The payer case manager is likely to be the person who is coordinating the activities. It’s up to the providers to give the payer case manager information, but the person in charge of the money has ultimate control," she adds.
As an independent case manager, Llewellyn often coordinates the work of all providers and payers. In this role, she is the only person on the team who works directly with the payer case manager. "With only one person, it’s more streamlined," she says.
The person who has the financial risk is the one who really is in charge at the time, but all case managers should work together to promote and facilitate good care for the patient, adds Gary Wolfe, RN, CCM. In some cases, there may not be an identified risk holder. For instance, the insurance company doesn’t have the patient in case management, but the hospital does. In that case, the hospital case manager might be the one to start the initiative, Wolfe says.
As an independent case manager in private practice, Wolfe has seen the value of coordinating case management throughout the continuum. "Although the outcome may be specific to your health care venue, a case management plan is really for the patient, and it should be supportive of all outcomes along the continuum," he says.