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TRANSCRIPT
BRIDGING THE GAP BETWEEN CONFUSION AND CLARITY IN HEALTHCARE
National Physician Advisor ConferenceNPAC2019
The Case Manager and The Physician Advisor: An Essential Alliance
Kathleen Fraser MSN, RN-BC, MHA, CCM, CRRNExecutive DirectorCase Management Society of AmericaLittle Rock, Arkansas
“Be the thermostat, not just the thermometer”
Dr. Martin Luther King
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Case management is neither linear
nor a one-way exercise.
The assessment responsibilities
will occur at all points in the process.
Facilitation, coordination, and collaboration should occur throughout the client’s health care encounter.
The case management process is carried out within the ethical and legal realm of a case manager’s scope of practice, using critical thinking and evidence-based knowledge. We are patient advocates.
Case Manager Skills Required For Successful Care Transitions!
Able to coordinate medical and behavioral interventions.
Professional, yet empathic demeanor.
Collaborate and advocate with all stakeholders to develop a care plan across the care continuum.
Focus on patient centered autonomy and assist the patient in defining goals.
Meaningful communication with patient, family, care
team, and claims professional.
Case management is a collaborative process promoting quality care and cost-effective outcomes in order to enhance the physical and psychosocial health of individuals.
“Alone we can do so little; together we can do so much.”
Helen Keller
Case Manager
Physician Advisor
Transitions of Care
Activation!
CM/PA Assessments are an Ongoing Process…Keep Them Fluid
• Keep assessments flexible, varying with presenting problem or opportunity.
• Regularly reassess patient/caregiver needs and progress in meeting objectives.
• Facilitate goal-setting discussions based upon their needs during all phases of their care.
• Assess effectiveness of interventions in achieving patient’s goals.
• Communicate changes to the health care team.
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Case Management and Physician Advisors can and do reach across the silos!
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Shared Roles in Education
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“It's not the load that breaks you down, it's the way you carry it.”
Lou Holtz
Core Aspects
Understanding the importance of the medical and psychological interface on health and cost in complex patients.
www.cmsa.org/ICMCase Management Society of America & Cartesian Solutions, Inc.™©
Modify Patient Beliefs and Behavior
• Empower patients to self-manage their condition
• Ensure that patients understand their risks if they don’t adhere to medication regimens
• Ask patients about the consequences of not taking their medications
• Have patients restate positive benefits of taking their medications
• Address fears and concerns
Behavioral Health Integration
• An estimated 26% of physically healthy Americans age 18 and older are living with a mental health disorder in any given year.
• 46% will have a mental health disorder over the course of their lifetime.
• An estimated 8% of Americans are in need of drug or alcohol abuse treatment.
www.cmsa.org/ICMCase Management Society of America & Cartesian Solutions, Inc.™©
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33% of hospital readmissions are due to medication issues
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“Drugs don’t work in patients who don’t take them.”
Dr. C. Everett Koop MD Former United States Surgeon General
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Facts about Medications
• 33% don’t fill • 75% do not consistently take • 60% cannot name medications • 20% take other people’s medications • Poor adherence = hospitalizations and repeats•Average adherence rates - 50-65% overall
Trust the Case Manager and the Physician Advisor Relationship
• Practice active listening
• Improve interviewing skills
• Provide open communication
• Use plain language
• Elicit patient’s input in treatment decisions
• Bridging the gap between providing quality care and being influenced by a data-driven model.
Source: http://www.acpm.org/?MedAdherTT_ClinRef
Collaboration Goals
KEEP A SENSE OF HUMOR
KEEP THINGS IN PERSPECTIVE
EMBRACE CHANGE
STAY CONNECTED TO THE INDUSTRY
ALWAYS HAVE A PLAN “B”
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How do you keep your passion for Case Management when our patients, their families, bosses, physicians, employers, adjusters, etc, etc, etc….
can drain the passion completely out of you?
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“The pessimist may be right in the long run, but the optimist has a better time during the trip.”
Anonymous
Waves of Change
