Financial assessments critical to providing care

The hospital case manager may be perplexed by the 70-year-old female patient who is always pleasant and cooperative but experiences frequent readmissions for congestive heart failure because she doesn’t follow her medication regimen. The case manager is not aware that the patient’s live-in grandson is stealing her Social Security check and barely leaving her enough money for groceries, let alone medication.

The case manager completes a comprehensive assessment to include a financial assessment of the patient’s ability to procure food, clothing, and shelter. He or she must also attempt to learn the patient’s expenses and barriers to accessing his or her funds. The assessment is critical to assisting patients meet the most basic of needs. This assessment is time-consuming and may be difficult, as many patients are reluctant to inform the case manager of the financial risks they face. The patient may also not be aware of how dire the circumstances he or she is in because, for the patient, this is normal.

The assessment may not be feasible to complete during a hospitalization. Therefore, it is incumbent on the hospital case manager in a population health model to hand over the remainder of the assessment to the case manager associated with the primary care provider or the medical home. Once the assessment is complete, the documentation of the financial circumstances must be recorded in the medical record, so it is available for all caregivers to read and consider for all of this patient’s care plans.

Residence within a disadvantaged neighborhood may be a predictor of unnecessary rehospitalizations. Ironically, the penalties incurred by the hospitals in these neighborhoods eradicate the social programs and safety net care they were able to provide to the residents (source).

Editor's note: For more information, see Case Management Guide to Population Health: Management Across the Continuum of Care.