Case management has been widely promoted as a method that can improve clinical outcomes and reduce healthcare costs. This article describes a cost-benefit analysis for a proposed nursing case management program that provides care for a low-income high-risk diabetic population in a rural county. Industry trends, objectives and functions of the case management program, timeline, financial plan, and cost analysis are described. The analysis indicated a potential net savings of 149,544 dollars annually. This would be a significant cost savings for the healthcare provider and funding source.
The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004. The purpose of this research was to validate the currency and relevancy of the certified case manager examination. The results of this study are shared in 2 parts of an article. Part I discusses the process the CCMC used for the development of the Case Manager's Role and Functions Survey Instrument (CMRFSI). The research leads to the identification of 6 new essential functions and 6 new knowledge areas, which describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the survey results and focuses on identifying the empirical activity and knowledge domains of case management practice, using factor analysis. It also discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, it summarizes future changes in the field of case management as perceived by those who participated in the study.
Case management services are not implemented uniformly or with the same levels of intensity. Case managers serve in diverse settings, have varied training and experiences, and individualize care at the patient level. The flexible characteristics of case management services pose challenges to, and accentuate the need for, successful ongoing evaluation. The purpose of this article is to describe a multimodal evaluation planning strategy that was applied to case management services delivered to pediatric Medicaid recipients within an enhanced primary care case management delivery system. The evaluation planning steps included describing the organization and case management program, identifying barriers to evaluation, outlining evaluation questions, specifying data needs, identifying sources of data, and selecting evaluation methods. The evaluation plan utilized a combination of case studies, monitoring, surveys, and trend analysis. The approaches outlined in this article are likely to be applicable to evaluating diverse case management programs and services.
This article presents the author's personal reflections and experiences in providing case management for patients with end-of-life issues. Through case examples and practical guidelines, the reader will gain an insight into dealing with terminal states in the acute care setting. References were drawn from recent literature on the subject, and were the stimulus to this piece.
Suzanne K. Powell, MBA, RN, CCM, CPHQ, is Editor-in-Chief of Lippincott's Case Management. New! Individuals receive online access with their paid print subscription. Visit the journal website (www.lippincottscasemanagement.com) and activate your subscription online via the REGISTER button on the top menu bar. You will need your 12-digit subscriber number, which can be found on your journal mailing label.
Case management organizations must often make a choice about whether to invest time and resources in pursuing external accreditation. The decision is a complex one and requires understanding of the interaction among many forward-looking variables. This study examines the use of computer-based tools to analyze the value of accreditation to support more effective decision making about whether to pursue accreditation.
Karen Babos, DO, MBA, is the Chief Medical Officer of United Resource Networks (URN), an organization that provides specialized solutions for complex medical conditions. More than 3,000 payers use URN's nationally recognized Centers of Excellence networks and associated services for the clinical and financial management of their kidney disease, transplant, congenital heart disease (CHD) complex cancer, and infertility patients. For more information about the URN, visit the Web site: www.urnweb.com.
Patricia McCollom, MS, RN, CRRN, CDMS, CCM, CLCP, is the President and Nurse Consultant for Management Consulting and Rehabilitation Services, Inc., and also Lifecare Economics, Ltd. located in Akeny, Iowa. She can be reached at [email protected].
In 1999, the Clinical Resource Management (CRM) group at Saint Alphonsus Regional Medical Center in Boise, Idaho, implemented a specialty-based nursing case management model for individual caseload assignment of all inpatient admissions. This model assigns caseloads by proportion determined by physician specialty type. This model does not consider patient acuity and may have weaknesses associated with self-report. In addition, time requirements for effective case management outcomes are not always reflected in admission volumes alone. This article describes the development and pilot testing of the Patient Acuity Case management Evaluation (PACE) measurement tool. Five phases of methodological development are discussed: (1) conceptualization phase, (2) content development, (3) Delphi technique using expert opinion and critique, (4) inter (intrarater reliability testing, and (5) pilot testing of acuity tool. Examples of instrument development throughout these phases are included. This instrument is expected to provide verifiable measurement of individual and group case management workload.
Thomas M. LaBrot, DC, holds diplomat status with the American Board of Quality Assurance and Utilization Review Physicians, serves on the Medical Directors/Provider Relations committee for American Association of Preferred Provider Organizations, and represents the National Association of Speciality Health Organizations on the NCQA Healthcare Practitioners Advisory Council. He is currently VP of Clinical Services for American Speciality Health—the nation's largest complementary healthcare company. Address correspondence to Thomas M. LaBrot, DC VP Clinical Services American Specialty Health, 777 Front Street, San Diego, CA 92101 ([email protected]).
Suzanne K. Powell, MBA, RN, CCM, CPHQ, is Editor-in-Chief of Lippincott's Case Management. P.S.: Lippincott's Case Management is excited to announce a new, added benefit to individual print subscriptions—online access! Visit the journal's Web site (www.lippincottscasemanagement.com) and activate your subscription online via the REGISTER button on the top menu bar. This will require your 12-digit subscriber number (found on your journal mailing label). It is archived back to 2000, so all the back issues plus the 2 supplements are available on the site.
David O. Bump, REMTP, FP-C, is Vice President, Program Development, and program director with Air Trek Air Ambulance, a nationally accredited fixed-wing air ambulance provider located in Punta Gorda, FL. A certified flight paramedic with more than 20 years of experience, he is on the board of directors of the International Association of Flight Paramedics and the Board for Critical Care Transport Paramedic Certification. He has authored several articles and lectured both domestically and internationally on a variety of air medical issues. He can be reached at [email protected] or at 1-800-633-5387.
Viki Solomon, BA, BSN, RN, CRRN, CCM, ABDA, has been a medical case manager and rehabilitation nurse for 20 years. She has held various executive board positions on local, state, and national committees. She currently is the President of Viki Solomon & Associates, Inc. and is devoted to providing medical care coordination with a specialty in catastrophic case management. She is located in Ft. Lauderdale, Florida. She can be contacted at [email protected].
Gary Corneal, MA, JD, began serving as President of InforMed Medical Management Services (IMMS) based in Annapolis, Maryland, in September 2005. From 1996 to 2005, he served as the President and CEO of URAC. He can be contacted at [email protected]. Bev David, RN, MBA, has served as the IMMS Director of Clinical Integration and Reporting since 2003. He can be contacted at [email protected].
Mindy Owen, RN, CRRN, CCM, is Chair of the Commission for Case Manager Certification (CCMC), the first and largest organization that certifies case managers. She is also Principal of Phoenix HealthCare Associates, LLC, a Coral Springs, Florida-based consulting firm specializing in case management, disease management, and managed care development and education. Address correspondence to Mindy Owen, RN, CRRN, CCM, Commission for Case Manager Certification, 1835 Rohlwing Road, Suite D, Rolling Meadows, IL 60008 ([email protected]).
Case management services are not implemented uniformly or with the same levels of intensity. Case managers serve in diverse settings, have varied training and experiences, and individualize care at the patient level. The flexible characteristics of case management services pose challenges to, and accentuate the need for, successful ongoing evaluation. The purpose of this article is to describe a multimodal evaluation planning strategy that was applied to case management services delivered to pediatric Medicaid recipients within an enhanced primary care case management delivery system. The evaluation planning steps included describing the organization and case management program, identifying barriers to evaluation, outlining evaluation questions, specifying data needs, identifying sources of data, and selecting evaluation methods. The evaluation plan utilized a combination of case studies, monitoring, surveys, and trend analysis. The approaches outlined in this article are likely to be applicable to evaluating diverse case management programs and services.
Kris Fricke, RN, CLNC, CCM, is President/Nurse Consultant of BiState Medical Review & Case Management, Inc, Waterloo, IL, serves the St. Louis—Metro East area, and can be reached by e-mail: [email protected].
