Becker's Hospital Review

74 Executive Briefing Sponsored by The Center for Case Management I n today's fragmented healthcare environment, case management can knock down siloes and help patients navigate their care amid the COVID-19 crisis. The essence of case management Bonnie Geld, CEO and president of The Center for Case Management, termed case management "a discipline that manages the nexus of care." This nexus is clinical, psychosocial and financial. "The goal of the discipline," said Ms. Geld, "is to improve or maintain health by coordinating care through addressing these various dynamics." Case Managers "tie together all of these silos . . . and look out for the entire arc of a patient's care," explained Tom Higgins, MD, CMO at The Center for Case Management. "The patient is always at the center in this increasingly chaotic and complex environment, which they need help managing." Inpatient vs. remote case management Inpatient case management is episodic, for a finite period. An inpatient Case Manager works with a multidisciplinary team in a hospital to prepare a patient to transition home or to another care setting. Remote case management provides coordination and supports patients following and prior to hospitalization. Goals include helping patients recover from an acute illness ,avoiding unecessassry hospitalizations, and managing chronic illness. Case Managers are constantly monitoring patients and can identify even subtle changes in a patient's condition. They are are excellent at initiating course corrections and mitigating potential health consequences. For hospitals and health systems, avoiding readmissions is extremely important. Hospitals with high readmission rates are subject to penalties. Also, hospitals must manage their capacity and don't want capacity negatively affected by preventable readmissions; this is especially true during the COVID-19 pandemic. Dr. Higgins said, "If we don'tavoid readmissions as one level of control, capacity issues may threaten the health of the organization." He continued, "The financial imperative is there for hospitals to invest in case management." The importance of clinical partnership Some individuals within hospitals see Case Managers simply as the people doing the discharge plan for a patient. This misses the big picture because Case Managers do much more than that. According to Ms. Geld, Case Managers pull together all of the information for a patient and present the physician with a comprehensive plan for the patient's transition and recovery. The Case Manager then works closely in partnership with the physician in managing the plan. "We cannot have a strong and effective case management program unless this discipline is seen as a strong clinical partner with the physician," said Ms. Geld. Effective case management will influence length of stay at hospitals, decreasing the cost of care. . From patients' perspective, effective case management results in higher satisfaction and ensures that patients make the best use of their benefits. Patients who utilize case management and social workers as their partners in health demonstrate improved patient activation, leading to better personal health outcomes. To advance the discipline, The Center for Case Management has developed tools to help Case Managers build their skill sets. These tools prepare Case Managers to build comprehensive care plans for patients and work in partnership with physicians to execute these plans. Dr. Higgins framed The Center for Case Management's goal as "spreading good practices across the country." Spreading these practices is done by training Case Managers, training physicians and other clinicians — who often have little training in case management — and even training patients. Case management during COVID-19 The COVID-19 pandemic has amplified the importance of comprehensive case management. During COVID-19, "We see the role of case management and telemedicine and telehealth growing exponentially," reported Ms. Geld. Many patients who have been fearfulto go into hospitals or visit their providers are turning to their Case Manager as an important connection to the health system. Case Managers help patients navigate their care journeys and educate patients as they return to care sites for treatment. Ms. Geld observed, "Other interdisciplinary team members are recognizing that Case Managers are becoming the hub for these patient populations who are still nervous about returning to their community settings. Case Managers are a lifeline to these patients as they try to navigate whatever illness they have." Even after the pandemic, Dr. Higgins said, "Telemedicine is here to stay." CMS and insurers have liberalized the rules and reimbursement for telemedicine, though there is still a great deal of confusion, with different codes, different requirements and different reimbursement rates. Dr. Higgins knows that going forward, payers are going to want to pay less for telemedicine. But he is hopeful that reimbursement will be adequate to encourage greater use of telemedicine when it is appropriate. Still, as important as telemedicine and tele-case management is becoming, it will never replace all in-person patient visits. Telemedicine provides just another tool for Case Managers to use in connecting with patients, coordinating care and partnering with physicians to improve clinical outcomes. n Clinical partnership amid COVID-19: The emerging importance of Case Managers

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