Authors

  1. Stutz, Linda RN, BSN, MBA

Abstract

Purpose/Objectives: The evolution of case management programs continues as health care systems adapt to the requirements and provisions under the Patient Protection and Affordable Care Act. One such provision establishes a new category of health care provider-the accountable care organization. These organizations provide a form of coordinated health care delivery. The successful integration of an accountable care organization, along with a better coordinated, higher quality case management care model, will provide better access to health care, improved care transitions and safety for the patients, and lower costs to the health system.

 

Primary Practice Setting(s): Acute-care hospitals; ambulatory care centers; and primary care physician practices.

 

Findings/Conclusions:

 

* Banner Health has experienced success, using a single standardized model for Case Management despite varying care settings.

 

* The standardized process allows the interdisciplinary teams to use standardized assessment tools, action plans, and workflows. As a result, Banner Health has experienced reductions in variations, duplications, and handoffs, as well as great efficiencies, clearer communication, and improved outcomes. In addition, auxiliary programs have been developed to support and mimic the standardized approach to case management.

 

* In 2012, the average length of stay for Banner Health was 3.81. This number represents an overall 7.52% improvement in average length of stay or a total of 66,986 total potential saved days across the 11 hospitals within the system.

 

 

Implications for Case Management Practice:

 

* A successful implementation of this type of case management model requires systematic changes to technological and organizational structures.

 

* The stewards of the case management model must be proactive in garnering and maintaining executive and financial support.

 

* By designing an electronic documentation system with one workflow and a standard set of data definitions, health systems will be able to provide standardization and reduce variations of care. This type of standardization creates a central database for easy reporting and decision making.

 

* Achieved successes, associated with improved clinical outcomes, can translate into considerable reductions in the controllable expenses for a health system.