Case management is a collaborative approach that analyses, plans, executes, organizes, supervises, and evaluates the options and services needed to meet patients' wellbeing and medical service needs. It fosters reliability and cost-effective actions and outcomes defined by Patient engagement, interaction, and infrastructure administration.
All stakeholders benefit from this approach since it maximizes value and produces positive outcomes.
Throughout the healthcare and social services professions, case management solutions are a specialized practice. The fundamental concept is that everyone benefits when clients achieve optimal wellness, self-management, and functional capability. The decision-makers include the patients who are being served, their support systems, health care delivery systems, care providers, workers, and various payer sources.
In addition, the case management process assists the patient and their family in navigating a complex mix of services and supports offered through a benefits plan, an organization or institution, and their community. It is frequently included in other healthcare operations such as care coordination, preventive medicine, and Care management.
According to statistics, 5% of emergency room visits patients account for 30% to 50% of emergency department visits, and all these high-utilizing patients may try ineffectively to meet their healthcare and related needs through their own, which is often inadequate, characterized by overuse of pricey, or underuse of appropriate health care and social services.
Case management is a broad term that describes a program that includes healthcare-related components of case management solutions but also stretches to a broad array of facilities, assistance, perks, and entitlement programs across many disciplines to which the patient may have access.
The worldwide health system has been strained by the ongoing coronavirus illness 2019 (COVID-19) epidemic. It's also resulted in a crisis that case managers and other healthcare workers have never seen before. At the same time, it has created chances for creativity and innovation, such as using digital and communications technologies in novel ways to assure the continuing supply of health-related services to those who need them, regardless of location.
COVID-19 has affected over 3.4 million people globally as of May 2, 2020, with 242,296 people died from the disease with an overall 7.11 percent mortality rate. COVID-19 global phenomena have been described as prevalent, catastrophic, and pervasive, and there are many more aspects of the disease for healthcare professionals to understand.
Case managers, as patient advocates, are in an ideal position to assist the necessary medical treatment or final care conversation, including advance care planning and procuring the appropriate legal documents that clearly state the patient's and support system's preferences and care goals.
There are 4 Levels of the Case Management Process. They are as follows:
Intake:
Intake is the first step in the case management process, and it serves as the foundation for all subsequent steps. This step involves gathering as much information as possible to create an accurate picture of the client's current situation. The client provides this information, and at this point, the client's needs are clearly stated.
Demographic data is gathered to assist the case manager in developing an effective care plan for the client.
The patient's current needs are identified ahead of time to assist case managers in determining the best course of action for the client.
When a client meets with the case manager for the first time, a relationship is formed. The path to establishing trust between the two parties begins with these initial interactions to determine where the client is and how best to assist them.
Needs of Assessments:
In level two, needs assessment, the information received at the previous level, intake, begins to arrange and take shape. At this level, the case manager evaluates all of the information at their disposal and works with the patient to learn their needs and goals and the path to achieving them.
The case management process thrives on tailored, custom plans, which are only effective if all parties involved - the case manager, the client, the client's family, and healthcare stakeholders - are on the same page about the end goal.
Reassessment is necessary regularly to ensure that the agreed-upon plan serves the client most beneficially.
Services planning:
Level three identifies concrete goals and responsibilities that will assist the patient in achieving their goal. The case manager puts together a strategy that considers all of the information gathered in stages one and two. The client's support system and other health providers are frequently consulted as part of the plan.
This step establishes a timeframe for goals, ensuring that the activities at hand are finished on time. Achievability is a desirable quality for any action planning, regardless of industry.
Evaluation and monitoring:
The final phase of case management solutions assesses the plan's effectiveness and ensures that the case manager and organization meet the client's specific needs. The plan and measurements established in level three serve as a framework for monitoring and evaluating progress.
These metrics then serve as real-time indicators of how far we've come. The case manager can then utilize this information to change course if necessary or continue if the strategy works well. While this may appear to be a reliable and satisfying method of evaluating progress, nothing beats actual data.
Using stories to evaluate progress can significantly impact the quality of service provided to a client. The case manager should rely on data obtained during the plan's implementation to employ these metrics in level three.
Need For Case management in HealthCare:
In response to the COVID-19 worldwide pandemic and its destructive nature, case management executives and professionals are at a crossroads in establishing collaboration and transparency with their respective health care leaders and providers.
Even though it may be intriguing to take a powerless stance in the face of the pandemic and the growing number of challenges such as cultural, personal, commercial, and expert; we have been enduring every day for the past several months, it is far more essential to face these challenges with confidence.
Without a doubt, as representatives and healthcare professionals, such as case managers, one must actively participate in protecting somebody's life and mobilizing adequate resources in innovative ways to facilitate the sustainability of safety, efficiency, essentials, accuracy, empathy, and patient-centered services while also being compassionate to oneself.
During the COVID-19 epidemic, professional case managers will have a unique chance to put their educational backgrounds, knowledge, skills, and competencies to use in providing case management best practices to the full extent of their licenses and scopes of practice. They are caring for COVID-19 patients with complicated diseases and needs while also verifying that non-COVID-19 patients, particularly those with numerous chronic or newly emerging conditions, receive prompt care.
Role of Case Management in Healthcare :
The information needed to rationalize the investment opportunity must be available to decision-makers. They must choose between competing investments to make the most use of their limited resources in most circumstances.
Let's see some of the most common concerns the Healthcare sector encounters with this process:
Identify an appropriate caseload:
There is no one-size-fits-all formula for calculating caseload. Case management departments must examine intensity, length of stay, and specific role duties to complete when balancing the caseload. It is also recommended that case managers be covered for weekends, holidays, vacations, and sick days.
Determine the model design:
The following step is to choose a model design. The most frequent design is unit-based, although additional models include product line, physician aligned, throughout the continuum, and by the payer.
As a result, whichever model you choose, make sure you have buy-in from the entire team and that everyone understands the case manager's job.
Case managers must ensure that all team members are included in the design process to understand their job and have reasonable expectations. They must also ensure that each case manager understands their responsibilities and can demonstrate results to back up those responsibilities.
Develop an appropriate budget:
When developing the budget, case managers must first consider the number of full-time executives mandated and other necessities such as devices and clerical support personnel. Significant factors such as operating hours and the working days of the week will also be required.
Professional development opportunities should also be included in the budget so that staff can stay up to date clinically. They must ensure that they engage in the organization's contracts with payers and providers as soon as possible to provide realistic goals.
Best outcome indicators for the department:
Case managers must choose outcome indicators for the department before collecting data such as length of stay, patient satisfaction, the turn-around time for tests, consults, treatments, denials, and cost per case to establish how they will measure the department's success.
Provider satisfaction, patient, family, and staff education, endorsing the right of patients and families to express their wishes, and assisting healthcare professionals in efficiently interacting with patients are all examples of "soft outcomes" that should not be overlooked.
Operationalize a healthcare case management software product:
Departments in case management should select a healthcare cloud-based case management software system that satisfies their requirements. All that endures ensures that the software you choose can support the case management best practices mentioned in the Medical Case Management programs.
Before considering computerization, a case management model should be manually operated to define a workflow process for at least a year. Most good software providers will inquire about the manual workflow process to determine how automation can best assist case managers and management departments.
The staff and the organizational training:
Case managers must deliver advancing technology to all case management staff and supplemental, less intensive training to the rest of the business. This type of training is a necessary procedure that is frequently overlooked, as case managers must ensure that training is ongoing to maintain everyone clinically competent.
Lastly, case managers must be prepared to reassess outcomes, make adjustments, and make program design changes as needed. In a nutshell, keep going forward and take the initiative.
Future of Case Management:
If at all feasible, the new paradigm will be to keep patients out of the hospital. Researchers must arrange the most appropriate post-acute patient care in the hospital and then evaluate and organize outpatient follow-up. However, not rocket science, most hospitals and healthcare systems are unfamiliar with this approach. Case management is becoming a technique that will be at the heart of every continuum of care program.
The inpatient service, acute care, and outpatient treatment mechanisms continuously monitor patients; each location requires various skills, abilities, and care strategies. Furthermore, patients with specific illnesses, such as heart problems, renal disease, and diabetes, require a disease-specific wellness program paradigm, requiring a disease-specific care plan model.
Technology will also play an essential part in this process. Many vital indicators, such as heart rate, blood pressure, temperature, oxygen saturation, weight, blood sugar, and exercise, can be monitored outside of the hospital. These can be sent to case managers in a passive manner, with alerts for unexpected outcomes. Software is now available to encourage medication and nutritional compliance, with automatic alerting of deviations. Telehealth will help with follow-up care, but it will never be a substitute for a physical checkup. In addition, new portable equipment will enable providers to perform various diagnostic tests in the comfort of their patients' homes. This process could reintroduce the house call as a valuable tool in the comprehension process.
CONCLUSION:
Although hospital executives are under much pressure to increase quality, efficiency, and profitability simultaneously, they're using various approaches and care delivery frameworks to help them do so.
Medical Case Management is one of the critical paradigms that is being used that is often underestimated.
It will become more critical as challenges increase.
Care processes are becoming more complex, as are quality standards and regulatory compliance obligations. Patients and clinicians alike are perplexed by the care systems and the decisions they must make.
A Case management healthcare technique that is created, built and maintained as a strategy is a perfect answer. A hospital's cloud-based case management services must contain a capability strategy, a reproducible structure, a uniform configuration of resources and people, and an efficient, internally connected workflow to be genuinely effective. Furthermore, case management services must be linked to the larger organization's operational and analytical systems from the outside.
Finally, this system requires a regulated evolution process to keep it new, efficient, and effective. Case management may be a potent weapon in achieving quality, productivity, and profitability in your organization if it is supported by suitable processes, tools, and information.