COLLABORATIVE CASE MANAGEMENT
A Peer-Reviewed Journal for Case Management and Transitions of Care Professionals I S S U E
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A P R I L
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ISSN
2328-448X
In This Issue:
Chronic Care Management and a Letter from our CEO
T H E O F F I C I A L P U B L I C AT I O N O F T H E A M E R I C A N C A S E M A N A G E M E N T A S S O C I AT I O N
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Assessing and Addressing Care Management Diane DiFiore, DNP, MHSA, RN, NEA-BC, ACM-RN Healthcare systems in the United States have evolved at a rapid pace over the past 30 years. During that time, the introduction and establishment of Title XVIII and Title 1 XIX , Diagnosis Related Groupings, ICD/ CPT codes and the Affordable Care Act have become an important part of the U.S. healthcare system. Compounding this is the detailed analysis each patient case requires to determine payer approval for inpatient admission and regulatory adherence. Length of stay, readmissions, hours in observation, delivery of notices to patients and auditing risks all fall under the purview of concerns within care management. Beaumont Health is a not-for-profit healthcare organization formed in September 2014 as a combination of three formerly existing healthcare organizations in southeastern Michigan. The company has a total net revenue of $4.7 billion (2019) and consists of eight hospitals with a combined total of 3,429 beds, 145 outpatient sites, nearly 5,000 physicians, 10,000 nurses, 38,000 employees and 3,500 volunteers. 8
LEARNING OBJECTIVES 1. Identify education and training deficits within the eight Beaumont Health Care Management Departments. 2. Establish educational goals to elevate and promote the education and development of the care management teams. 3. Design a standardized method of onboarding, competency training and certification opportunities for care management employees. Challenges Beaumont Health faced within the eight hospitals’ care management departments are not only the external complexities of navigating within the healthcare and payer systems but also the internal variation of roles and responsibilities among care managers, social workers, utilization reviewers and support staff across the system. Does the care management team truly understand the “why” behind what they do, what the payer is requiring, and how they balance being a patient advocate and a fiscally responsible member of the healthcare system?
These valid questions needed attention in order to best support the priorities of level setting education and competency among the eight care management departments. The intricacies of care management functions, the concerns regarding role variation across sites, and the lack of foundational understanding of what the care management staff does and why, required an intensive assessment. Care management had been locally operated at each of the eight acute care sites with no coordination from a central corporate model. The corporate care management department was established in April of 2018. Beaumont’s corporate care management department believed it was vital for the organization to have both a centralized and decentralized approach for orientation in order to motivate and retain employees, decrease turnover, increase productivity, improve staff morale, facilitate learning and reduce anxiety of new employees (Ragsdale & Mueller, 2005). Decentralized orientation has existed at the sites in various forms (i.e., use of a checklist, preceptor, observation,
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etc.) however no centralized program was in place. The need for standardized education with our staff and leaders (current and new), how we onboard, and how we maintain levels of competency were identified as priorities. This goal and priorities soon became a reality. The endeavor of creating a customized central approach to orientation was a threemonth journey. The main goal within corporate care management was to raise the standard for training and education within the care management division. This goal had a multipronged approach: corporate onboarding, competency training and certification. Implementing a corporate onboarding program, establishing an educational competency program and promoting certifications elevated the standard for the care management team. This comprehensive approach supported the foundation of understanding the complex world of care management, payers and regulations, to name a few. While doing site visits at each of the eight hospital care management departments, some staff members expressed a novice understanding of basic concepts within care management even though they may have possessed four to five years of experience. Common themes from all sites was a desire for more information, education and training about the multifaceted healthcare scope and the need to be kept updated about rapidly changing practices. Historically, sites provided information based on past practice and “how things have been done.” This discovery demonstrated that years of experience in this field did not equate to expertise and competence in the area. Benner (n.d.) explains the concept of novice to expert as a combination of strong educational foundation and personal experiences. Benner goes on to describe that oftentimes a nurse will “know how” without “knowing that.” Our goal addressed building their level of expertise and helping each participant gain more of “knowing that” through formal educational support.
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“The intricacies of care management functions, the concerns regarding role variation across sites, and the lack of foundational understanding of what the care management staff does and why, required an intensive assessment.”
CORPORATE ONBOARDING Utilizing various key stakeholders and teams was a priority. Meeting with each of the eight sites care management teams and leaders fostered more discussion about the goal of enhanced and expanded training and education and was positively received. A draft of the onboarding slides was presented to the
care management leadership group and staff to ascertain feedback on content and flow. Based on the groups’ feedback, the corporate onboarding program progressed into two, four-hour sessions offered each month for new hires within the care management department. Onboarding Part 1 addresses the history and evolution of healthcare, national and local care management standards, the patient experience and communication techniques. Onboarding Part 2 addresses the compliance and regulatory requirements and transitions of care. Internal experts were utilized as subject matter experts in providing content information about the revenue cycle, financial clearance, motivational interviewing, patient choice and the patient experience. All new and current care management leaders, care coordinators, social workers, utilization managers, data analysts and support staff are invited to attend care management onboarding part 1 and 2 classes. These classes are taught by the care management educator and site leaders utilizing an interactive approach with videos, case scenarios and open discussion. At the beginning of the class, each attendee takes a pre-quiz to assess the participant’s baseline knowledge. At the conclusion of the session, the same questions are repeated in the post-quiz to determine comprehension and effective presentation of the material. Spread throughout the two-part sessions are videos of Beaumont Care Management staff describing their role and the work they do. This adds a personal touch to help recognize the important work of the care management team. Following each session, the attendee completes an evaluation rating the value of the material and any additional comments. This feedback is used to update the training materials. Starting in April 2019, a 60-day post-onboarding survey has been sent electronically to all attendees who attended class two months prior to assess for application and value of the material. Based on class evaluation and 60-day follow up survey 9
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feedback, the onboarding presentations have been regularly updated. Another layer of corporate orientation requires that all new care management leaders meet with the corporate care management team. In addition to attending onboarding part 1 and 2 classes, new leaders learn care management dashboards, electronic medical record navigation and reports, and the content within the care management website. They are “buddied” with a leader colleague at another care management acute care site for more training and observation and utilize an extensive checklist for tracking purposes. After 90 days, the new leader meets once more with the corporate care management team to review and assess additional educational needs and support.
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modules were chosen by each site based on priorities of their team. Physician Advisors are required to complete all modules for baseline competence.
Additionally, a certification review course, hosted by ACMA, was provided in the fall of 2019 to continue to improve and enhance care management service delivery and
ABOUT THE AUTHOR Diane DiFiore, DNP, MHSA, RN, NEA-BC, ACM, is Director of Care Management Development and Education at Beaumont Health.
ONGOING EDUCATION THROUGH COMPETENCY AND CERTIFICATION A strategy in meeting the continuing educational needs of the entire care management division is through ongoing competency training. Compass is the method of choice for the next three years. In April of 2019, the teams began to utilize the Compass modules for further validation of learning. Five required modules were assigned for care management, social work and utilization review staff to complete. Three modules required for all sites to complete were Patient Status and Level of Care, Overview of Resource Management, and ACO Models, Quality Measures and Bundled Payments. The remaining two
has been assessed through the onboarding evaluation feedback (12-month average is 98%). Comments shared within the evaluations have been very positive, noting an increase in the participants’ knowledge of compliance and regulations, communication techniques and scope of practice. A follow-up survey is sent to attendees 60-day post onboarding classes to assess for content application in daily work. Results indicated that 70% to 80% of the respondents rate the use of content as extremely to somewhat helpful in their day-to-day work. Future outcomes data will be measured through employee satisfaction, patient satisfaction and employee turnover.
FOOTNOTES
professionalism. According to the National Hospital Case Management Survey, 47 percent of Accredited Case Management (ACM) credentialed professionals indicate that certification has increased their professional knowledge and competency (Allen, 2019). Since the launch of the new onboarding program in January of 2019, outcomes data
1. Title XVIII established regulations for the Medicare program, which guarantees access to health insurance for all Americans, aged 65 and older, younger people with specific disabilities, and individuals with end-stage renal disease. Title XIX established regulations for the Medicaid program, which provides funding for medical and health-related services for persons with limited income: mainly covering pregnant women, adults with dependents, people with disabilities and the elderly. Retrieved from https://governmentprograms.laws.com/title-xviii-and-xix-of-thesocial-security-act
REFERENCES 1. Allen, M. Hospital system encourages and supports certification in case management. (March 2019). Collaborative Case Management. 68, 21. 2. Patricia Benner novice to expert-Nursing theorist (n.d.). Retrieved from http:// nursing-theory.org/nursing-theorists/ Patricia-Benner.php 3. Ragsdale, M., & Mueller, J. (2005). Plan, do, study, act model to improve an orientation program. Journal of Nursing Care Quality, 20(3), 268–272. Retrieved from http:// journals.lww.com/jncqjournal/ Abstract/2005/07000/Plan,_Do,_Study,_ Act_Model_to_Improve_an.13.aspx
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