Deploying your modern care management model successfully is contingent on two key areas:
1) Defining patient management priorities
2) Creating a process that maximizes care team members’ assignments and time.
Let’s take a closer look at how to support these two objectives.
1. Use data to allocate and effectively redeploy the inpatient care team to specific units
I want to begin by highlighting a specific example where a healthcare organization used analytics to create an optimized inpatient workflow.
When starting their care program redesign effort, leaders at MedStar Franklin Square Medical Center in Baltimore, Maryland, examined which units to assign case managers based on data that tracked interventions across a six-month period.
They analyzed data such as total admissions, emergency department visits, case mix index, the timing of the patients’ initial assessment, payer mix, the proportion of discharge planning allocated to social interventions of patients with different acuity levels, length of stay, denials, utilization of resource functions and more.
Based on this analysis, MedStar concluded that complex medical units (e.g., stroke, renal, pulmonary, ICU, observation unit, oncology and intermediate care) experiencing greater psychosocial need would be staffed by care teams with a higher share of social workers. Leaders at the 347-bed hospital decided to shift to a triad model of case management (composed of case managers, social workers and utilization management staff), centralizing utilization review duties and freeing up RN case managers to focus on medically complex patients–especially on units with the greatest need for medical case management.
Conversely, this freed up staff from lower acuity patients who didn’t require that level of hands-on care. Their findings revealed not all patients needed in-depth management and to try to create equality regardless of medical complexity would create unnecessary resource drain. This was only made possible by a close analysis of the data, which revealed a more beneficial deployment of staff and resources.
2. Review pros and cons of common ambulatory care model types
The following graphic shows four conventional ways to staff and deploy an outpatient-based care management team.
Each option has its advantages and disadvantages to consider.
Embedded within Primary Care Practices
This ambulatory care model achieves the greatest level of integration with the primary care team. If securing physician buy-in of an outpatient team is a challenge, this model promotes fast care management buy-in from office staff and improves care coordination through easier handoffs.
At the Advisory Board, we typically recommend the ambulatory care team report to the inpatient care management department as opposed to the office manager staff or individual primary care teams.
Centralized within Administrative Office
This is a model typically employed by a larger health system with a number of satellite clinics and facilities that nevertheless need to share data, workflows and patients themselves. In these instances, many organizations elect to centralize outpatient-based care management out of a centralized administrative center.
Remote care management can reduce resource and staffing deployment time while enabling a larger case load than would otherwise be possible. However, this model type requires routine program communication within practices to ensure ongoing contact with specialists, not to mention a clear understanding of the current best practices and utilization patterns. Health systems that pursue this type of ambulatory care model must place special emphasis on plotting face-to-face patient contact and engagement, which can be more difficult when working across multiple facilities.
Dedicated to a Complex Care Clinic
Still other healthcare organizations opt to refer their patients to a complex care clinic dedicated exclusively to ambulatory care. Think of, for example, a general practitioner supplementing their own care with the expertise of a clinic what specializes in outpatient management.
On the plus side, it’s great to have care managers work as part of a broader team managing all patients on a panel. Be aware, however, that many patients are reluctant to switch doctors, even if just for a brief period of time, or to change to a new geographic location to see their primary care provider. You should review a new location carefully if launching or referring to a complex care clinic and even consider co-locating, at least to begin.
Mobile and/or Community-based Team
Still other organizations opt not to require their care managers to be within a given facility at all. Working remotely gives care managers the opportunity to more fully view the patient’s condition across the care continuum. Telecommuting also allows these staff members to meet regularly with other colleagues. If care is administered in the home, this model is even more convenient for the patient.
To help remote staff meet in person and share work experiences to learn from one another, consider leasing or dedicating traditional office space for co-working and collaboration. This type of mobile-based model requires close supervision of company processes to ensure the employee is following standard care practices to meet performance tracking goals.
3. Determine your optimal care management structure
The following illustration provides a list of care management functions ranked in a top-down approach that are regularly seen at the system-wide, regionally distributed and/or practice/community level.
I recommend reviewing these functions to determine the optimal care management structure that can be realistically supported by your care team, particularly in the outpatient setting.
Of special note is the three “Key Questions” included in the graphic that serve as a starting point to advise your organization-wide strategy:
What non-primary care needs are prevalent among my patient population?
Care management is increasingly viewed as something that goes well beyond primary care, with social determinants of health just as important in the workflow of the modern case manager.
What in-practice care management roles can be easily scaled across multiple practices?
Again, this is about maximum utilization of resources. Roles and functions that can be easily mimicked across clinics and patient demographics are an excellent starting point for getting your new care management process up and running.
What care management functions do not need to be done in person?
In order to ensure your processes are as efficient as possible, determine what administrative tasks and touch points could conceivably be taken care of without face-to-face patient interaction.
Before deploying a new or redesigned care management model, think through your patient management priorities and their alignment with your care team’s capabilities, whether inpatient, outpatient or other. Determining the right scale for the right care service and model structure across multiple hospital units, physician practices or other settings calls for principled processes to drive efficient patient and staff management. The use of data analytics and a review of commonly deployed care model types, including what worked and what didn’t, can help inform your decisions.