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The best way to make sure case management is taken seriously is to demonstrate its financial value, says Victoria Champeau, BSN, CCM, MS, director of quality and care management for the Bloomington-based Minnesota Healthcare Network, a group of more than 600 primary care and specialty physicians who joined together and formed a health care system. "Chief executive officers and chief financial officers don’t understand quality of care, but they do understand value if you put it into financial terms, " she says.
If you’re squeamish about looking at your job in financial terms, remember that without your job, or the money to support your department, you can’t continue to be a patient advocate. When you want money to support your job or your department, think of it as putting a business plan together and going to a bank, Champeau suggests. "You don’t talk about quality of life to a banker. If you want to make a point with them, you tell them about return on investment. That’s how to get support for case management."
Case managers often become intimidated when people start talking about financial points, but they can put everything they do into financial terms and demonstrate the value, she says. It’s not difficult to put the value of case management in financial terms. You simply take historical information from your file, or demographic information from the government or health plans, and compare your outcomes after you implement a case management project.
At a basic level, case managers are doing cost-benefit analysis every day when they manage a patient’s benefits by pointing out that a particular test or procedure will save X amount of dollars. "Case managers do it on an individual incident level," Champeau says. "They need to do the same cost-benefit analysis on an entire episode of care or an entire department over time."
Here’s an example of how you can calculate a return on investment for a program. For a disease management program, you might want to calculate how much was saved by reducing hospitalizations or lengths of stay:
• Calculate the number of days in the hospital for your patient population during a base period, such as a year, before you had the disease management program. Or take information from government statistics, health plan data, industry benchmarks, or actuarial standards.
• Then look at the actual number of days in the hospital after you implemented the program and subtract that from the hospital days of the previous period.
• Multiply by the cost of hospitalization. If hospitalization for a particular group of patients costs an average of $1,000 a day and you have a 200-day decrease in hospitalization length of stay, your cost savings amount to $200,000.
• Finally, add the cost of putting the program together, such as salaries, supplies, and equipment, and subtract that amount from the cost savings to get the value of the program. You can measure the cost of medicine, the number of home care visits, the number of days in therapy, the reduction in readmissions, or cost savings by using out-of-hospital treatments — anything that can affect the cost of care.
You can calculate the value of case management on an individual case basis, for a patient population, patients in a particular program, or the case management department as a whole.
|Five Steps to Calculating the Value of Case Management|
|1.||Know your historical information.|
|2.||Know your actual information.|
|3.||Calculate gross savings.|
|4.||Subtract the cost of case management and get net savings.|
|5.||Calculate your return on investment.|
Champeau urges case managers to learn to take credit for what they do. If you don’t give yourself credit, no one else will, she says. She gives an example of a pharmaceutical sales person who is paid a bonus based on product sales in the ZIP codes she covers. The sales person doesn’t say, "The sales might have occurred because I talked to the doctors, but maybe that wasn’t the case," Champeau says. "But case managers’ normal reactions are, Maybe I kept the patient out of the hospital, but maybe it was a fluke.’ Case managers should take credit that the patient avoided hospitalization because of their intervention," she adds.