Case management is a healthcare process in which a professional helps a patient or client develop a plan that coordinates and integrates the support services the patient/client needs to optimize healthcare and psychosocial goals and outcomes. The case management process helps the patient and their family navigate complicated services. It supports available within a benefit plan, an organization or institution, and their community.
Concerning cost-effective outcome analysis, Hudon et al. found that approximately 10% of patients account for approximately 70% of all healthcare expenditures. Statistics show that 5% of emergency department patients account for 30 to 50% of emergency department visits, and these highly utilizing patients may unsuccessfully attempt to meet their healthcare and related needs on their own, which often is ineffective, characterized by overutilization of expensive or underutilization and uncoordinated effective health care and social services.
As a social worker, you may be called upon to provide case management services to your clients. But what is case management in social work?
Case management is a process whereby social workers help clients navigate the social service system. This may involve providing information and resources, connecting clients with community services, and teaching them how to advocate for themselves. Case management can also help reduce costs associated with health care and improve medication adherence and overall health outcomes.
Challenges in Healthcare Case Management
Case management is a critical healthcare practice that connects patients and vulnerable populations to the medical care, social services, community resources, and education they need to improve their health, well-being, and lives.
Case managers evaluate patient needs and plan, facilitate, coordinate, and advocate for healthcare options and services to improve the quality of care and social and clinical outcomes.
Despite its benefits, many healthcare organizations and providers need help implementing and managing case management programs in clinical environments. When services and care are poorly coordinated, undue pressure is placed on emergency departments, and patient health can suffer. Some challenges faced in healthcare management include the following:
Coordination of care across multiple providers
When health care providers don’t communicate effectively with each other around a patient’s care, resulting in – for example – repeated lab tests, drugs that don’t work when you take them together, more trips to the doctor’s office that could have been handled with a phone call, and other negative impacts that lead to confusion and higher out-of-pocket costs for patients.
Managing complex patient needs and comorbidities.
Healthcare systems, medical education, and research worldwide are designed to deliver care for individual diseases. However, complex long-term conditions (LTCs) and multimorbidity are rising. The existing systems need to be more efficient in caring for people with multimorbidity, and a more comprehensive approach is necessary. The Royal College of Physicians (RCP), in conjunction with the Association of British Clinical Diabetologists (ABCD), organized a conference to improve understanding of LTCs. Common LTCs like chronic obstructive pulmonary disease (COPD), heart failure, dementia, chronic kidney disease (CKD), diabetes, chronic steroid use, severe mental illness and physical disease, and Parkinson’s disease were discussed. The interactive sessions focused on the views and experiences of various medical experts in the UK on care pathways, care networks, and care models that can help manage LTCs.
Ensuring timely and effective communication
By their very nature, healthcare facilities must always be prepared for a crisis. Unfortunately, ineffective communication can lead to gaps and breakdowns in implementing crisis management plans.
Healthcare administrators play an essential role in ensuring proper communication in an emergency by establishing plans for relaying information to patients, family members, employees, government officials, and news media. These plans may include detailed communication plans via websites, social media, and call centers.
Balancing quality care with cost constraints
Evidence of the direction of the association between healthcare cost and quality needs to be more consistent. Most studies have found that the association between price and quality is slight to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types represent waste.
Maintaining patient engagement and adherence
Patient engagement (PE) is a well-known strategy introduced and implemented by pharmaceutical and medical device companies for patient compliance and adherence to treatment protocols during clinical trials and care processes. This can affect a broader range of outcomes, such as the quality of treatment decisions and quality of care outcomes. Few studies have paid attention to it. The involvement of patients is one of the crucial stakeholders of health care in their treatment, and it creates controversial opinions about the potential outcomes of their engagement in various aspects of healthcare.
Solutions for Effective Healthcare Case Management
Implementing case management software
In the intricate landscape of modern business operations, case management software emerges as a pivotal tool, facilitating streamlined processes and enhancing overall efficiency. As organizations increasingly recognize the transformative power of tailored case management solutions, a comprehensive guide on building such software becomes imperative.
Utilizing data analytics and insights
Data analytics is transforming the healthcare industry, from diagnostic imaging to administrative and billing systems. The data analytics trend accelerated during the COVID-19 pandemic, revealing the current system’s gaps. Data analytics helps doctors predict patients’ medical interventions and treatments based on their age, medical history, and possible scenarios and medication outcomes. Data analytics also helps hospitals manage their resources better, such as increased demand for medical equipment, beds, and staff during surges in patient volume, as well as helping healthcare institutions provide tailored treatments to patients, with data and AI-based systems doing the heavy lifting and delivering actionable insights.
Coordinating care through multidisciplinary teams
Multidisciplinary teams (MDTs) are at the core of improving people’s health. They represent a structured group of healthcare practitioners from various health and social care fields who come together to support individuals with complex needs. MDTs are proactive when engaging with individuals and families, especially in decision-making, while connecting with other teams and services within their communities to provide the best possible solution and outcome.
MDTs are proven to be highly effective when providing care for children with complex care needs, as well as people with mental health concerns and complex health conditions.
Leveraging telehealth and remote monitoring
The ability to monitor certain aspects of a patient’s health from home has become an increasingly popular telehealth option. Remote patient monitoring lets providers manage acute and chronic conditions, and it reduces patients’ travel costs and infection risk.
Fostering patient-centered care and engagement
Following patients in their home circumstances for a prolonged period supported the development of meaningful relationships between students and patients and provided continuity. Mechanisms contributing to learning patient-centredness were triggered in a meaningful relationship and continuity context. This study’s most crucial learning mechanisms were reflecting, contextualizing disease in a natural person’s life, broadening perspectives, and engaging with the patients.
Best Practices for Healthcare Case Management
Conducting comprehensive patient assessments
The healthcare system can feel like a whirlwind to patients who, before receiving any treatment, must schedule an appointment, complete a pile of paperwork, and take part in a comprehensive health assessment. This is how medical professionals determine the patient’s status and degree of urgency.
This process can provide detailed insights that are invaluable to making an official diagnosis and determining how to proceed with treatment. This can also be a great time to reassure patients and take steps to make them feel as confident and comfortable as possible.
Developing personalized care plans
One of the main benefits of individualized care is improving patient outcomes. Patients receiving treatments tailored to their specific needs are more likely to see positive results. This approach to care can also enhance patient satisfaction, as patients feel seen and heard by their healthcare team, which ultimately leads to a stronger patient-provider relationship.
Facilitating seamless transitions and handoffs
Ensuring safe and seamless transitions starts well before hospital discharge. Successful transitioning of patients from the hospital to other care settings is a dynamic, multifaceted process in which healthcare systems, hospitals, providers, patients, and their families share responsibility. Models or interventions such as Better Outcomes for Older Adults (BOOST), the Care Transitions Intervention (CTI), and the Transitional Care Model (TCM) were developed to improve transitions across the continuum of care. These models are especially beneficial for high-risk and older adult populations, who are often hospitalized, move frequently across care settings, and experience high rates of post-discharge complications, readmissions, or morbidity and mortality.
Providing ongoing support and follow-up
Patient follow-ups in healthcare serve as a crucial aspect of the healing process, extending beyond clinical procedures to ensure comprehensive care. They involve monitoring the aftermath of ailments, providing medical updates, and fostering ongoing collaboration between caregivers and patients. These follow-ups contribute to the continuity of care, emphasizing a commitment to the patient’s well-being. They form a systematic approach to track progress and address lingering concerns, aiming for a holistic understanding of the patient’s health. In the broader context of healthcare, patient follow-ups play a vital role in maintaining a structured and thorough approach to the recovery process.
We are continuously evaluating and improving care.
Current evidence suggests the benefits of CQI in improving health care are still being determined, reflecting both the poor quality of evaluations and the complexities of health services themselves. Further mixed-methods evaluations are needed to understand how the health service can use this proven approach.
How PlanStreet Can Help
Given the multi-stakeholder dynamics of modern healthcare, it becomes crucial to use systems that allow data collection, centralization, easy access, and rapid communication. Scheduling follow-ups and team collaboration also highlight the importance of powerful case management software in managing healthcare services. Automation and efficiency allow your team to buy back highly coveted time with clients. Optimizing your billing, scheduling, and state-of-the-art Power BI analytics reporting is one of the many reasons why PlanStreet is the right software for your organization or agency. Our fully configurable healthcare module allows you to customize intake forms, centralize data, bring teams together, and create actionable insights from robust reports. Schedule an introductory call with us to find out more.