Use data in determining shared goals

Data is an essential tool in understanding the patient population that will guide the focus of your program. Both internal metrics and community/public health data will provide strategic focus to case management practices.

It is essential to understand the progress being made with the patient population as well as the organization’s health. The Quality Realm Core Measures in the inpatient setting and Healthcare Effectiveness Data and Information Set (HEDIS®) measures in ambulatory arenas help teams understand the organization’s ability to maintain quality of care and medical outcomes.

Core measures are standardized best practices designed to improve patient care. U.S. hospitals must also submit performance measures to The Joint Commission and Centers for Medicare & Medicaid Services; additionally, performance on these measures is publicly reported.

HEDIS is a tool that more than 90% of U.S. health plans use to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across five domains of care (see NCQA HEDIS® & Performance Measurement).

The profession of case management is all about influencing outcomes. No other discipline within the healthcare community manages to position themselves to improve and maximize reimbursement, manage or reduce cost, and avoid penalties. Because case management is a synergistic practice (working with RNs, physicians, and social workers), it offers a formula for success.

A good case management program, and its leadership, understands and leverages data to inform practice and improvement, communicates trends that demonstrate its knowledge, and motivates and engages teams to act. Data must be transparent, user-friendly, organized, and informative.

Strong case management leaders live by this formula: Stay ahead of the information, communicate with knowledge and confidence, and use data as a call to action and engagement.

For more information see: Longitudinal Case Management: Designs Across the Continuum of Care.