Description:-

The Centers for Medicare and Medicaid Services (CMS) has instituted linkages between cost and quality through value-based purchasing and other cost-saving measures such as payment penalties for high readmission rates. These changes have created the first link between the cost and quality of health care. These factors now require that the case management models begin to change and adapt. The early case management models no longer meet the needs of the changing healthcare landscape!  It is for this reason that hospitals and health care systems must look thoughtfully and carefully at the design of their case management models, the roles used, and staffing ratios of their case management departments. 

This program will review contemporary, best practice, case management roles, and models. The program will begin with the contemporary case management roles used in hospitals today. This will be followed by a model review which will include descriptions of the two most commonly used models, the key differences between the models, as well as how they should be designed and structured. This will be followed by the pros and cons of each model and how the department might be designed to accommodate each model.  The best practice staffing ratios for each model will be discussed as they apply to the roles of the RN case manager and the social worker as well as strategies for optimizing existing resources.

The program will conclude with a discussion of the steps needed to re-engineer a case management department and tips for identifying the best model for your organization.

Course Outline:-

• Why change your structure now
• Model of care definition
• Contemporary case management roles
• Comparison of the two models
• Integrated model
• Access point case management in the integrated model
• Collaborative / Triad Model
• Departmental structure
• Staffing ratios in both models
• Key differences between models
• Similarities between models
• Advantages and disadvantages of each model
• Key planning and implementation steps. 

Learning Objectives:-

• Understand the roles and functions of acute care case managers and social workers
• Describe the best practice case management models in the acute care setting
• Review how to staff a case management department.

Why Should You Attend?

No hospital can afford to remain stagnant in an environment that seems to be changing at a lightning pace.  While the Medicare programs had remained fairly constant for many years, CMS now routinely changes the penalty and reimbursement structure in addition to adding new expectations such as the Two-Midnight Rule, and other similar rules and measures.  Nevertheless, it seems that the case management department often appears to be the last department to be updated or enhanced to meet the new challenges imposed by the Affordable Care Act and Value-Based Purchasing. 

Selection of the most appropriate model will depend on the needs of the organization, the available resources, and the expected goals and outcomes. Each case management department should ensure that they have the correct roles, functions and staffing ratios. This program will provide you with the tools that you will need to identify the changes or upgrades you may need to make in your own case management department. 

Who Should Attend?

• Directors of Case Management
• Directors of Social Work
• RN Case Managers
• Social Workers
• Directors of Quality Management
• Vice Presidents of Nursing
• Directors of Finance
• Vice Presidents of Operations
• Hospitalist