Physician Practice

Improve clinical care with case management strategies

Physician Practice Insider, May 16, 2017

Case managers may not be physicians, but they are integral to the quality of patient care.

Regardless of whether a case manager’s role includes clinical or medical case management, utilization review, discharge planning, or a combination of these and more, if the case manager can advocate for the patient during the medical encounter, he or she can influence good clinical care, says Jackie Birmingham, RN, MS, clinical leadership at naviHealth: A Cardinal Health Company, headquartered in Brentwood, Tennessee.

While their roles may vary by facility, in most instances case managers are also involved in managing the resources needed to ensure the patient has the best possible outcomes. “As an advocate for the patient, the case manager is looking holistically at the patient encounter to progress the patient through the system,” says Cheri Bankston, RN, MSN, director of clinical advisory services for naviHealth. “That includes monitoring for overuse or underuse of resources.”

Case managers should be the glue that holds everything together. “They are involved in all aspects of patient care, from insurance coverage, to duplicative testing ordered, getting medications changed, to caregiver availability after discharge,” says Bankston.

While some case management interventions may affect only one patient, others can improve care for entire populations of patients. “Case managers get prescriptions paid for by the hospital, by churches, by community agencies that made a huge difference in a patient’s health,” says Bankston.

“But they also intervene on a personal level,” she adds. If, for example, a patient has social issues that may affect his or her ability to take medication as directed or maintain his or her health, it doesn’t help to simply get the prescription filled. “The case manager is the one that picks up on those issues and intervenes or pulls the team and the family together to come up with a plan,” says Bankston.

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