Q&A: Prioritizing case management functions
Q: What case management function is the most important for achieving the deliverables expected?
A: The access, UR/CDI, care coordination, and discharge planning functions are equally important functions in achieving targets. In today’s hospitals, which of these three functions is the most fundamental to build a model? In other words, is the “center” of the work the chart, the payer, the physician, the team, a primary nurse, the nurse of the day, a nurse practitioner, the patient, the family?
All of these choices make sense, but the epicenter is the action at the bedside, i.e., the care interventions by multiple disciplines. Without those interventions, there would be no care, and case management would be irrelevant. Therefore, care coordination is the most fundamental function in hospital case management. Care coordination involves three steps: knowing the story, weaving the story, and using the story.
- Knowing the story: What is the background leading up to this admission, the patient’s attribution of why he or she is in the hospital now, the set of symptoms and possible causes, the family’s response, etc.?
- Weaving the story: How do all of these facts “add up”?
- Using the story: What should be done about the immediate and anticipated situation?
All other case management functions, such as UR or discharge planning, stem from the actual care. It is impossible to manage a case well without knowing the condition, the diagnosis, the disease trajectory, any related quality measures, and the ideal sequencing (using critical paths, treatment plans, or other method). It is definitely impossible to manage a case if the clinical staff members do not respect the clinical knowledge of the case manager. Therefore, care coordination should be at the center of a case manager’s activities. However, care coordination is usually the most complex function and may be left for last “if there is time.” Unless a case manager and social worker start in the center of a case—at the bedside or family’s side—they will never get past the pressures of talking to payers for reimbursement or “moving patients out.” In fact, case managers and discharge planners are being so pressured, some are making final discharge arrangements before there is even a diagnosis.
For more information, see Case Management Models: Best Practices for Health Systems and ACOs, 2nd edition.
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