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