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There is not one specific way to improve case management and develop the best teams. But a good first step is to identify team members and to focus on the correlation between their skill sets, engagement, and outcomes.
Hospitals are struggling to meet the goals of value-based payment models. Value-based models are designed to improve outcomes, such as quality of care, satisfaction, and complications, while reducing costs. The impetus comes from CMS, which has set quality and efficiency standards for hospitals.
Long-term support services should provide “person-centered care,” according to a 2014 rule from CMS. In everyday patient care, this translates into a focus on learning a patient’s wants and needs, which helps the case manager align treatment with the patient’s desires.
An Ohio hospital’s population included people with lower income, less education, and many health challenges. Case management could help once these people entered the hospital, but the challenge was to prevent the problems that first led to ED visits and rehospitalizations.
As urban hospitals grapple with length of stay penalties, they must help their patients solve everyday problems. Lack of resources is a fact of life for inner city residents, and hospitals need to find a way to help those patients overcome those obstacles — and reduce length of stay.
Investigators recently studied technological solutions to improve diabetes patients’ engagement. They found multiple digital diabetes management systems that could help. These solutions include smartphone apps, devices with built-in connectivity, and coaching and support provided remotely through human or automated connections.
Antimicrobial resistance represents a serious risk for Medicare beneficiaries and the general public. CMS is finalizing an alternative new technology add-on payment pathway for antimicrobial products designated by FDA as Qualified Infectious Disease Products.
The RN case manager’s expertise is the vital link between the individual, the provider, the payer, and the community. Successful outcomes cannot be achieved without using specialized skills and knowledge applied through the case management process.
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Financial Disclosure: Author Melinda Young, Author Jeanie Davis, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, and Nurse Planner Toni Cesta, PhD, RN, FAAN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.
