Improving and Innovating Your Care Management Processes

by Mary Kay Thalken, RN, MBA on Aug 30, 2018

female doctor with patient in hospital roomIn early August 2018, Ensocare hosted a webinar entitled “Getting The Most Out of Your Care Management Model.” In it, Tomi Ogundimu of the Advisory Board discussed modern best practices for care management models, areas for potential improvement and specific examples of hospital systems and the steps they’ve taken to address the shortcomings of their own care planning.

Today, we’d like to follow up her insights with a few steps you can take to evaluate and innovate care management at your facility. Informed by my own clinical nursing background, I’d like to talk about some of the things I’ve encountered and the ways in which we’ve seen our own Ensocare clients address these challenges.


Silos: Great for Staff Members, Terrible for Planning


Let’s talk about silos for a moment.

Silos have their place and can even enhance productivity by keeping your team members focused on their day-to-day responsibilities. You need your case managers to maintain focus exclusively on the patients under their supervision, your discharge planners to administer the processes within their purview and your clinical staff to see to the clinical aspects of the hospital.

When the duties and responsibilities of these individuals become muddled, you lose efficiency during critical moments. This can lead to a disruptive patient experience, a lack of proper oversight or negative developments in the patient’s recovery or rehabilitation.

This is where silos come in. Silos enable administrators to place boundaries on the workflows of their team members. They ensure a person’s expertise is put to maximum use. In this way, they can be invaluable for an organization.

But there’s also an aspect of care management where silos can be detrimental to maximum efficiency, and that’s during the planning and evaluation stages of care management.

When determining areas for organizational improvement, you cannot have blinders on. You have to evaluate the full scope of the enterprise rather than just whether or not each individual silo is working effectively. Persons from multiple silos should be encouraged to contribute their own voices and shape the care discussion, yet it’s critical that decision-makers take the totality of that information and identify areas that create positive improvement across all silos.

Let me give you an example of what I mean: when conducting an evaluation of your care management model, you might solicit the opinions of case managers, nurses, informaticists, support staff and other clinical experts. During this research period, perhaps you discover your case managers are functioning at exceptional levels, interacting with the patients under their care on a regular basis and ensuring those patients stick to the plan provided. But from a view outside the silo, you notice these same case managers’ duties overlap with those of a support team, members of which are also reaching out to patients. In fact, patients are growing frustrated because they’re getting asked the same questions by multiple people, so they begin to think the disparate portions of the organization aren’t communicating with one another.

Knocking down silos to conduct a full evaluation of the bigger picture is critical, as it enables you to identify issues like these that may otherwise go unaddressed. It’s only after this evaluation that you can build those silos back up to maintain efficiency.


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After you’ve taken an overview of your entire care management model, you can begin to properly coordinate care across the totality of your team.

Ms. Ogundimu spoke to the value of segmenting patients, and thus the persons assigned to their care management, based off of a series graduating criteria. Her example was one of staggering assignments first by ambulatory care setting, then by diagnosis, practice and finally level of risk.

This makes sense when you think about the clinical needs of each specific sliver of the patient population.

You don’t want to start segmenting by risk, for instance, because even though two patients might have similar chances of readmission, they come to that status in very different ways. Someone going through in-home occupational therapy has different needs than a person whose biggest challenge is access to one of the social determinants of health, such as adequate food or transportation. Both could be labelled as high-risk, but they’re high-risk for very different reasons.

When you start with ambulatory setting first, then diagnosis, practice and risk, you can group patients together based off of specific needs and establish processes that make sense and maximize your resources.

This also makes it easier to establish and monitor goals. When everyone is on the same page, when populations have been segmented appropriately, the metrics your organization should aim for are more readily delineated.


Clinical Vs. Non-Clinical


The best care management models are those that enable clinical staff members to see to clinical needs and non-clinical staff members to oversee other functions. End of story.

I travel the country regularly to visit health systems and provide an introduction to our care transition software. I’ve seen many resource-strained facilities where nurses spend as much time, if not more, filling out paperwork, taking care of discharge procedures, and being pulled from one place to the next simply because they’re the staff members available for those job functions.

I get it; I’m a nurse too and I was in those shoes once. I understand the desire (and the tacit expectation) to be everything to everyone in a healthcare setting. But I also understand how frustrating it is to be forced to step away from the bedside, from important patient interactions, to oversee a clerical function that another capable individual with the proper training should be able to take over.

When evaluating care management models, administrators must go in with the ultimate goal of letting clinical experts oversee clinical aspects of patient care and hiring other support team members for other important duties. In this way, you let care team members work top of license and care improves.


In-House Vs. Outsourced


(You might be thinking, “Is she really saying in-house vs. out-house?" That would be really strange…)

One final, critical consideration during care management planning must be addressed, and that’s whether you bring people onboard to implement and maintain your newly efficient care management model or hire an outside vendor to provide this service for you.

This ultimately boils down to a combination of resources, funding and the size of your patient population. It’s not uncommon for larger health systems to put together their own RN-led case management call center to oversee the management of patients outside the hospital. Smaller facilities, meanwhile, who want to free up their clinical staff for clinical duties, may find it in their best interest to look to outside forces for this responsibility.

The decision must ultimately be made on a case-by-case basis. Because you ideally have already evaluated the totality of your care management structure, put the proper processes in place and determined how best to utilize your clinical and non-clinical staff, the answer at this point should be evident, particularly if you know your budget (specifically, if you are currently able to hire additional FTEs.)

Modern care management models are more complex than ever, and addressing this complexity isn’t always easy. It requires a willingness to think outside the box and re-evaluate years of what initially looked like progress but turned out to be an escalating series of inefficiencies. Once you step back and look at the full totality of your patient experience and your own approach to care, you can identify the areas of improvement that will ultimately aid your facility for years to come.

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Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.