2019 ACMA National Poster: Changing the Culture in Case Management

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Changing the Culture in Case Management: Moving from a Blended model to a Triad model of Care Delivery Trenda Ray, PhD., APRN, Holly Naramore, BS; Katie Broadus, MSN, RN; Tammy Lukacs, MSN, RN, CCM; Melissa Hurst, LCSW; Melissa Slater, BSN, RN, ACM. Care Management Department, University of Arkansas for Medical Sciences, Little Rock, AR BLENDED MODEL • • • • •

Patient-Centric approach

RN Care Managers and Social Workers divided patients evenly. Both RNs and SWs performed the same job functions. RN Care managers on floor were responsible for completing medical necessity screenings on patients. Each patient only had one specialty involved in their care team. Care Management teams were service-based, so case load varied and covered multiple floors/units.

Inpatient Care Manager

TRIAD MODEL

What has changed for each role? RN Care Manager • • •

Social Worker

Act as primary point of contact for hospital staff Drive the overall plan of care through coordination with interdisciplinary team and oversee execution of transition plan Attend CHAT daily

• • • •

Focus on patient’s psychosocial needs in collaborative partnership with RN Care Manager Organize interventions for patients based on assessment Act as patient advocate and provide support to families as appropriate Attend CHAT daily

Ensure appropriate utilization of services and level of care for all patients from admission to discharge Ensure proactive management of denials and length of stay based on medical necessity Attend CHAT once per week, or as needed to address utilization management concerns

• •

Inpatient Social Worker

ED Social Worker

Utilization Review Nurse •

Patient

Utilization Review Nurse

ED Care Manager

ROLES AND RESPONSIBILITIES Utilization Review Role: Utilization Manager License: RN Responsibilities: • All utilization review: initial and continued stay

Care Management: Care Coordination Role: Care Manager License: RN Responsibilities: • Clinical care coordination and progression • Transition planning initiated at admission • Identification of psychosocial needs for case referral with SW

Care Mgmt. Assistant

Initial Assessments

Psychosocial Management Role: Social Worker License/Education: SW License Responsibilities: • Psychosocial assessments and interventions • Transition planning for complex patients with psychosocial needs

Unit-based assignments, with included weekend coverage for all roles

Moved to Unit-based

RESULTS

Care Coordination What needs to be done to meet treatment goals and transition patient to the next level of care?

Utilization Management Is the patient receiving clinically necessary services in the most cost effective setting?

Transition Planning Where can the patient’s post hospital care needs be met most effectively and are there resources?

Social Work Assessment Are psychosocial issues identified and interventions developed to support care progression and transition planning?

Final Assessments

CHAT- COLLABORATIVE HOSPITAL DISCHARGE TEAM

-

Participants in CHAT

Facilitator Nursing Care Manager Social Worker Allied Health Partners Provider/Provider Team

-

-

Re-assessments

Discussion in CHAT

Reason for admission Medical Milestones Goal for the day Barriers to discharge Estimated Discharge Date Transition Planning Needs Patient/Family Concerns

Admission UR Reviews

Concurrent UR Reviews

Outcome of CHAT

Execute on daily goals Resolve barriers to discharge Communicate care plan to patient and family Reduce length of stay Improve patient and staff satisfaction

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