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Day two of the conference stretched into the early evening with the final symposia running from 4:15-5:45 p.m. One of these learning sessions, which was packed to near-full capacity, covered the realm of hospital case management from the vantage point of past, present and future—and from the passionate perspective of case management veteran Stefani Daniels.
The session, titled “Best Practices & Future Trends in Hospital Case Management,” began with an introduction from former CMSA president Jeff Frater, who shared the surprise he felt when his career, some years ago, transitioned him from the insurance side to the hospital side. Frater acknowledged the important—and difficult—work that hospital case managers are undertaking in the current health care environment.
This work, this set of roles and responsibilities of the present-day hospital case manager, was subject to the incisive examination of Daniels, the founder and managing partner of Phoenix Medical Management. Daniels broke down the history of hospital case management into three distinct eras, each with their own definitions and ideas of what a hospital case manager should be and how a department should operate.
The first era, which took place in the mid-1980s, she calls the “clinical case management model.” This model stemmed from the work of pioneer Karen Zander and approaches hospital case management with the following description: “The nurse at bedside is best positioned to work with the physician to effectively manage progression of care, reduce excessive costs, and plan for timely discharge.”
The second era, beginning in the late 1980s and spanning through today, are called “functional models.” These models of hospital case management shifted the paradigm of care. According to Daniels, “action moved from the nurse at the bedside to the two primary functions thought to impact LOS and cost: utilization review and social work/discharge planning.” This paradigm shift resulted in a dramatic decrease of social workers employed within hospitals, and it meant that role function was equivalent to task completion.
The third era, which has been extant and emerging for the past decade, is the outcomes model, which is summed up by the following descriptor: “Processes are identified—through discovery or design—to optimally manage progression-of-care.” The outcomes model, which Daniels refers to as “Hospital Case Management III,” is aligned more closely with how hospital demands have changed over time, and when working properly it unites in-the-trench case managers with hospital executives.
“If you think of hospital case management as progression-of-care management, you will start to see how the C-suite is thinking,” Daniels says.
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