Case managers are a valuable component of any healthcare facility’s care team, whether they are in discharge planning or utilization management roles. As healthcare evolves, so too do the roles and expectations for the facility’s staff, making it critical for case managers and other team members to periodically evaluate whether their career goals align with their current work.
Social determinants of health are social factors, such as homelessness, illiteracy, a history of childhood trauma, and joblessness or underemployment, that can affect a person’s health. Coding for these factors is important because CMS officials now use some of them to adjust quality measures for patients who are dual-eligible for Medicare and Medicaid, and coding these factors may help shape future health policy.
Case managers must begin to learn the skill of brokering for care. The goal of private payers is to provide the most cost-effective care that meets medical necessity for services and increases likelihood for recovery.
Health literacy can have a major impact on patient outcomes. If a patient doesn’t understand his or her condition, the reasons for treatment, and how to properly take medication, the patient could experience a relapse or adverse reaction.
Anita is a 76-year-old patient who cannot be insured. She has no income and came to the U.S. on a green card that expired many years ago. Anita has end-stage renal disease and can no longer care for herself. Her disease has progressed so dramatically that she will never be able to stand or walk on her own again. What can a case manager do in this complex case to ensure Anita receives care?
