Case management is a relationship-based profession that benefits health systems, patients, colleagues, and case managers. Establishing strong relationships with representatives from the long-term care continuum, including skilled nursing facilities, rehabilitation centers, memory care units, and assisted living and independent living communities, is important for case managers.

Challenged with employing enough staff in case management departments, the need for expertise in every role, and the increased requirements from payers, case management leaders are evaluating centralizing utilization review. This centralization carries both benefits and challenges, some of which are amplified because of the current healthcare climate.

As telemedicine use increases, case management professionals can harness its benefits to improve outcomes and provide a better experience for patients and physicians. COVID-19 played a large part in the increase as providers worked to minimize exposure to the virus. However, many patients still need proper monitoring.

A healthcare organization’s Medicare Bundled Payments for Care Improvement Advanced (BCPI Advanced) program resulted in lower hospital readmission rates. The program reduced readmission rates from 30% to 19%.

Before pediatric psychiatric patients are discharged from the ED, carefully document the visit and create a follow-up plan with a primary care physician or mental health professional. For patients presenting with suicidal ideation, a social worker or mental health clinician should develop a safety plan.

Every day, case managers face pressure to achieve optimal outcomes in a multitude of scenarios. At the core of each case is the patient’s understanding of medical care, their ability to think critically, make decisions about their care, and use good judgment. Capacity, competency, coping, and choice are the core considerations every case manager should examine with each patient.