Care Management – Implementing It Successfully In Inpatient And Outpatient Settings – Part 1

For a Care Management program to be truly comprehensive and successful, it is vital to apply it to both inpatient and outpatient scenarios. In the first of a two-part series, we share with you some requirements of such an initiative in an I inpatient setting.

The healthcare sector has witnessed several waves of regulatory changes and sky-rocketing competition in recent times. As a result, management teams at facilities across the country have resorted to going back to their drawing boards to develop the perfect strategy that can help them cope with such a demanding environment. The one tool that most of these bright minds recommend, after careful consideration, is a comprehensive Care Management system. Such an initiative has the potential to resolve most challenges including soaring healthcare costs and lack of patient loyalty. However, for such a program to work well, it is critical to implement it throughout the patient base which means that all inpatient, as well as outpatient cases, should be included.

We bring forward some key requirements for such a program to work well in both inpatient, and outpatient settings.

Inpatient Setting:

  1. A Trained Emergency Room – The number of people who visit an ER regularly makes up for a significant chunk of the ER workload. Many of them tend to believe that they need immediate medical attention even when, in reality, they may not. Consequently, they overburden the ER, causing extended wait times that negatively impact those who genuinely need quick assistance. ER teams that are well-versed with the fundamentals of Care Management can spot such cases early on and hand them over to Case Managers (CM) who can ensure that the right specialists address the issues leading to frequent ER visits.
  2. Aligned Hospitalists – Hospitalists who take over the charge of a patient’s care post-admission are a vital link in the care continuum. It is crucial for these physicians to work closely with CMs as they can provide all the clinical inputs needed for them to operate efficiently.
  3. Embedded Case Managers – CM teams need to be deeply entrenched within healthcare facilities so that they can collaborate with all other stakeholders. Working in isolated silos is not wise when it comes to CM initiatives. Each person involved in the care of a patient holds a relevant piece of the jigsaw puzzle without which the entire picture cannot be understood. CMs should be able to access all these pieces and put them together to determine which resources to mobilize in their quest to offer adequate support.
  4. Shared EMR and Software – Automated tools that make patient information accessible and also tie in activities like utilization management and claims management are a tremendous asset for CMs. Such tools help simplify their job. Instead of scrambling here and there in search of all the necessary case-related information, CMs can pull out whatever they need from an interconnected web of systems which also gives them access to data stored by third party providers.
  5. Educated And Enlightened Special Services – Intensivists or trauma services staff who understand the principles of Care Management are a critical link in the overall chain. These specialists work in tandem with Case Managers to provide holistic care to patients so that issues that cause frequent visits to the hospital are identified and fixed.

In the next part of this series, we will talk about the requirements of Care Management in an outpatient setting. A Care Management program that runs seamlessly in both these settings is in every sense a comprehensive one as it takes into account all types of patients and conditions and helps you maintain positive customer experience across your patient base.

For more information on how experts at Mirra Health Care can help you set up a robust Care Management Program at your facility, send us an inquiry through this page.


Sign up for the daily newsletter: