How a case manager can help you coordinate care


In the early 1990s, Barbara Starfield, a pediatrician and health services researcher, identified the four key attributes of primary care: first-contact care, continuity of care, comprehensive care and coordinated care.

[See also: Case managers and physicians align in Connecticut care model]

Two decades later, primary care providers are still working – and struggling – to make those features the reality at their practices, and with the Supreme Court recently upholding the Affordable Care Act, the concept of coordinated care has become even more significant.

Committed to achieving care coordination at your practice? Consider bringing aboard a dedicated case manager, if you haven’t already. Having a case manager (also referred to as a care coordinator or nurse health educator) can provide your practice with a deeper connection to its patient population, which will help them achieve better healthcare outcomes.

Why you need one

A study from May of this year found that 90 percent of healthcare organizations were using case managers, and a huge area of growth was in primary care. Fifty-eight (58) percent of primary care organizations reported using them in 2012, compared to just 14 percent in 2011.

This growth is attributed largely to the expansion of the patient-centered medical home (PCMH) and accountable care organization (ACO) models of primary care administration. In light of that, you may think a case manager is unnecessary at your practice if you’re not interested in becoming a PCMH or ACO – but you’d be thinking wrong.

Regardless of healthcare reform, coordinated care is critical to primary care, and using a case manager is the easiest way to achieve it.

A case manager is usually a registered nurse, which means she possesses a great deal of first-hand healthcare knowledge and experience. But she doesn’t use it to deliver clinical services or tend to the administrative needs of your office.

Instead, a case manager uses her expertise to conduct patient education, condition management advice, coordinate appointments, communicate among various provider organizations, work with Medicare or a patient’s private insurance, and generally just help patients navigate the maze of the American healthcare system.

A case manager becomes your patients’ point-of-contact and oftentimes serves as their advocate when it comes to fighting problem claims, securing hard-to-get appointments, and making sure their healthcare data gets to into the right hands.

In this article from amednews, one physician said her practice’s case manager does things she could do, but doesn’t have time to. Considering how valuable a physician’s time is, that makes a case manager one extremely valuable asset.

How to get one

Hospital-owned providers, especially those who are recently acquired, are frequently approached by their health organization to place an appointed case manager into their practices. Others are being approached by health insurers with a similar offer.

The introduction of a case manager via placement by an outside entity makes some doctors leery, especially those accustomed to handling any and all hiring decisions.

Yet the advantages to having a case manager around are so great that -- despite hesitations -- if the offer is posed to you, it’s wise to consider it, so long as the health system provides you with an opportunity to interview the candidate, plan out the scope of authority you’d have over her execution of job duties, and decide whether she’s a good fit for your practice.

Those who aren’t offered such placement – or can’t shake skepticism about taking in an outside rep – should consider bringing in case managers for the sake of their patients. Speak to colleagues who already have case managers working in their practices.

Ask around for recommendations, write up job descriptions based on the qualifications and duties of their existing case managers, and solicit a new hire if you’re ready to make the addition.

A case manager can make your practice more patient-centered and enhance your services through increased accessibility, continuity, comprehensiveness and – most importantly – coordination. That’s the kind of primary care performance that’s been decades in the making…and can be a reality in your practice.

Do you have a case manager on staff? How has it impacted your patients?

Want to learn more about achieving high-performing primary care? Check out this resource.

Madelyn Young is a contributor who specializes in covering practice management, medical billing, HIPAA 5010, ICD-10 and revenue cycle management. You can read her work on Power Your Practice and the CareCloud Blog.