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The realities of managed care

The demand for case management nurses has only increased, as the new realities of managed care have placed an ever-growing emphasis on maximizing care while containing costs.

As a result, case management nurses often face a dizzying array of challenges.

Angi Gragg, MSN, RN, ACM, senior clinical adviser for the American Case Management Association, has experienced many of these challenges first hand, serving in a number of roles, including as a pediatrics case manager and case management system director.

To help case managers succeed, Gragg offered these tips:

Develop relationships

One of the biggest challenges case managers face, Gragg said, is “making in-roads with physicians to let them know we are there to assist them.”

In her most recent clinical setting, Gragg said, her case management program developed an attending RN role, with case managers assigned to physicians. She said that the program resulted in expedited discharges, decreased lengths of stay and increased patient safety and care.

Stick to the scope

Gragg said case managers should avoid “scope creep” – essentially, trying to “do things for all parts of the hospital” – and stick to their scope and standards of practice, even as they are asked to “do more with less.”

Be involved

Case management leaders need to be involved in leadership of their hospitals. “They need to be very involved with the direction of the hospital,” she said.

Be partners & allies

Case managers work with many people: patients, physicians, social service providers and medical professionals of all types, as well as insurance companies. To more effectively work with these various parties for the good of the patients and the healthcare organization employing them, case management nurses should take care to build relationships based on partnership, rather than adversarial negotiation.

With physicians, for instance, she said work to educate them “to let them know we are there to assist them” rather than serving as the “status police.”

When dealing with insurance companies, “be clear about the picture of the patient and [with] supporting documentation,” Gragg said.

For patients’ families? Employ technology and other strategies to help families “be more involved, even if there is a great deal of distance between the patient and their families,” particularly to encourage better planning for what happens after the patient returns home.

And when dealing with other nurses? She advised developing “better tools” to improve communication between staff and case managers, from “white boards in the (patient) rooms to daily huddle meetings.”

By | 2014-11-21T00:00:00-05:00 November 21st, 2014|Categories: National|0 Comments

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