DorlandHealth

The late-afternoon symposium on hospital case management delivered a game-changing revelation. Though it has been developing for the past decade, a paradigm-shifting trend in hospital case management is now fully upon us. “Case management is no longer about utilization review and discharge planning,” proclaimed presenter Stefani Daniels. “Hospital case managers are now expected to reduce clinical costs associated with practice variations.”

This transformation is wrapped up in the third era of hospital case management as defined by Daniels, the founder of consultancy firm Phoenix Medical Management. She refers to this as the “outcomes model” era, or Hospital Case Management III. According to Daniels, the outcomes model is characterized by a group of six defining features, including:

1. Proactive advocacy. This includes strong patient advocacy, a reduction of both clinical and financial risk, enhanced communication, and vibrant patient education.
2. Progression-of-care. This centers around proactively facilitating the patient’s navigation. The case manager will “move from completing tasks to influencing activities that impact progression-of-care,” according to Daniels.
3. Assertive physician partnerships. “The case manager’s primary customer is the physician,” says Daniels, who lists real-time collaboration as an essential component of this emerging feature.
4. Inclusive infrastructure. There will be an entirely new blueprint of what case management departments will look like. And the transformation has begun, with skill mix, job description and expectations all in flux.
5. Continuous value improvement. “What are we doing on a day-to-day basis that improves our quality for our patients?” asks Daniels. Workflow restructuring will be up for change as will a focus on proactive vs. reactive strategies.
6. Practical application. Where do the grand case management ideas fit it? “If you can’t measure it, you can’t manage it,” Daniels says.