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Special Report
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In 2 this section, we bring you the hard-to-place content that is vital to our practice nevertheless. For instance, you will find here the entries to the official 2009 Case Management Writing Contest, which focused on innovative practice. These gems reveal what day-to-day practitioners are doing to increase the fluidity of their case management departments. Check this space often, as there's sure to be the addition of more valuable, be them hard-to-place, resources.
2009 Case Management Writing Contest
The results are in. In-the-trench case managers who practice their art of advocacy day in and day out have waxed poetic about their recent successes touching on the theme of innovative practice. We have the honor of presenting you with the four winners of this year's contest, who have drawn on their experience in emergency settings, behavioral health, and hospital settings to describe transformational programs and initiatives abetting the cornerstones of your practice, from transitions and advocacy to coordination and communication.
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Wednesday, 10 June 2009 18:55 |
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Dorland Health's 2009 Case Management Writing Contest returned some exceptional stories on the theme of innovative practice. These vignettes are a testament to the strength that is inherent in our practice and also to irrepressible power of invention. Let your fellow practitioners fill you in on stories of best practice that have elicited superior results in both organizational and personal realms.
Empowering “Care-itis” in Case Management
By Lisa K. Alberte, RN, BSN, CCM, MS, CRC, ABDA
Telehealth Monitoring: A Disease and Case Management Program
By Carmen Castillo, RN, BSN
Growing a Case Management Model of Care
By Kecia Cowden RN, BSN
Hand in Hand
By Cheryl Darnall, RN-BC
Behavioral Health Case Management: An Innovative and Timely Dance
By Karin Douthit, LCSW
It Starts with a Vision
By Jan Garman RN, BSN, MBA
Seamless Communication and Smooth Transitions
By Gail LaPointe, Nora Arbeene and Laurene Dynan
Creating a Safe Future
By Barbara Ledig, RN, MA, CMC
Enter My Heart
By Terrie Magro RN, MA
Defining a Model of Care Coordination
By Lynne A. Major, MSW, LCSW, CCM
A Unique Collaboration: Nurse Case Managers and Vital Decisions Counselors
By Pamela Molinari, RN, BSN, CCM, CRRN, and Helen D. Blank, PhD
Installing a Proactive Approach
By Jennifer Regan, RN
Casting Life Preservers in a Turbulent Sea
By Debra A. Robinson, RN, CCM
The Benefits of Routine Screening
By Marc Schnall, LCSW-R
A Friend of Case Management
By Lori Smet, MN, RN, CCM
Never Miss an Opportunity
By Kelly Wood, BSN, RN |
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Written by Kelly Wood, BSN, RN
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Tuesday, 09 June 2009 18:34 |
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One of my truly rewarding experiences this year was something very small yet prodigious in its effect. I am a care coordinator, and this experience took place while offering service to a wounded service member who was being treated for a mild traumatic brain injury (TBI).
This service member had just completed his third combat tour of duty, having been medically evacuated from the combat zone for his injury. One day, I called him to set up an appointment. Before we got very far, he said to me, “Wait, wait, Mrs. Wood, I have to get a piece of paper. I have so many pieces of paper here it is hard to keep them straight. I have to keep all these notes due to memory issues from this TBI. Having to keep all these notes all over the place makes me feel so stupid.”
I made a modest suggestion. “Would a PDA be helpful?” I asked him. “It sure would. When you’re using a PDA, people think you are smart,” he responded. We both kind of laughed. But I took what he said seriously. I quickly make arrangements to get him a PDA.
By getting this service member a PDA, I was able to dramatically change his quality of life. Sometimes, something as seemingly minor as this can make all the difference in recovery. My patient is improving every day, and with the use of his PDA he feels pretty smart doing it.
I completed making his appointment that day, but more happened than setting up a future meeting. It was a small token, a brief conversation, a momentary encounter. But its message rings home: never miss an opportunity to change someone’s life. It could just end up changing your own.
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Written by Lori Smet, MN, RN, CCM
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Tuesday, 09 June 2009 18:34 |
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As a case manager in an acute care setting it was frustrating to see that there needed to be changes made in health care and that Medicare rules were all about what we couldn’t provide for our patients. Then in 2006 I became involved in a Medicare Demonstration Project for High Cost Beneficiaries.
Our Clinic in North Central Washington, with a consortium Clinic in Bend, Ore., are part of an innovation in telehealth to monitor patients with chronic disease to positively impact their health care and of course reduce costs. It is called the Health Buddy® Program, after the telemonitoring device installed in the patient’s home. We are one of the most successful programs implemented by Medicare and have completed the first three years of the project and been granted an extension for another three years.
The Health Buddy® appliance (Health Hero Network) allows the nurse case manager to monitor the daily condition of patients with chronic disease, heart failure, COPD and diabetes. The patients answer focused questions to aid in management of their chronic disease, i.e., weight, blood glucose, and heart rate, and receive interactive educational information regarding their disease. A computer program provides the risk stratification of the patient responses which the case manager monitors through a password protected website. From the case manager perspective, the Health Buddy is a valuable tool to help prioritize the care of patients and make appropriate and timely interventions. For the patient, the Health Buddy is a link or access to the health care system and the Primary Care Provider via the nurse case manager who is their advocate.
The Health Buddy program was conceptualized as a disease management program but we have modified that to create an individualized care management program. We feel that we have been more successful than remotely monitored telehealth programs due to our integration within the clinic system; we have access to the electronic medical record, we develop a relationship with the patients from the time of enrollment, and we are identified by the patients as a “go to” person who can help with issues, answer questions, and act as liaison with the physician.
Our case manager staff includes a certified diabetic educator; two master’s prepared nurses; one clinical nurse specialist, and a certified case manager and a nurse who is pursuing certification as a diabetic educator. These advanced practice nurses provide creative interventions based on the relationship they have developed with the patient, which is not possible with a phone-based distance program. Their combined experience goes beyond the script, and beyond the simple alerts revealed by the Health Buddy dialogue in their assessments and interventions.
In consideration of the shortages of nurses and providers and the costs of health care we are currently experiencing, innovations such as ours will need to continue. At this rural North Central Washington site four nurses have been able to positively impact our patients’ health and meet the savings target required by the demonstration agreement. We must start working smarter, not harder.
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Written by Marc Schnall, LCSW-R
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Tuesday, 09 June 2009 18:33 |
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FEGS provides case management services to the chronically mentally ill residing in Nassau County, New York. Services include assessment, engagement, linkage to resources, crisis intervention, care coordination and discharge planning. The program assists clients in all aspects of life, including medical, psychiatric, social, educational, legal, housing, financial and entitlements.
The research literature indicates that individuals with mental illness have challenges in accessing medical care for physical health issues. These individuals are at more risk and are dying in greater numbers from illnesses like heart disease, diabetes and stroke. Of particular concern is this demographic often does not have access to treatment, thus the importance of assessing the need for health care is imperative. This project aims to better identify health issues of clients served and to further improve their access to health care for these issues.
Coordination of care among service providers is too often infrequent or does not occur at all. Clients are typically seen by multiple health care providers; however, there is little communication among these providers. One of the primary tasks of a case manager is to improve health care access and the quality of care by facilitating coordination among service providers.
The aim of our project is to improve access to medical care for consumers with mental illness. This is a multistep project that will initially look at screening, assessment and intervention by case managers around the physical health issues of clients enrolled in the program.
The performance indicators are as follows:
1. The percentage of clients screened for health and wellness during their assessment. The target for this indicator is 100 percent. The four main indicators are smoking, alcohol use, dietary habits/nutrition, and physical activity level.
2. The percentage of clients with health and wellness needs who are referred to treatment for those identified health and wellness needs. This includes referral or linkage to a program dealing with the specific issue, including Weight Watchers or similar program, smoking cessation programs, self help/support groups, and physical fitness activities.
3. The percentage of clients who attend health and wellness programs. Once referral is made, monitor their attendance at the program.
4. The percentage of clients who adhere to information provided in health and wellness programs. This may include the client demonstrating an understanding of information related to health program and an implementation of lifestyle changes as a result of the health program (assessed through improved health status, for example, lower cholesterol levels, lower blood sugar) or successful completion of health program like smoking cessation.
The health and wellness screen identifies and prioritizes health issues so clients can address these with the assistance of their case manager as a care coordinator. In conclusion, the development of an assessment tool around health issues got case managers to focus more on their client’s health. The initial results reveal a positive change in client’s behaviors and attitudes toward improving their own health. This, in turn, has fostered better cooperation and a partnership effort between client and case manager.
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Written by Debra A. Robinson, RN, CCM
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Tuesday, 09 June 2009 18:33 |
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I am one of a number of lifesavers who works for Keystone Mercy Health Plan, a Medicaid managed care organization that cares for more than 300,000 underserved and underprivileged people in Philadelphia.
My department, the Rapid Response Outreach Team (RROT), is tasked with being the first responders for our members. We throw the initial “lifeline” to help guide them to successful outcomes. Our member population is quite diverse and so are our methods of reaching them. The RROT department calls members who are new to Keystone Mercy to check for any urgent problems. We call members who frequently use the emergency room instead of visiting their doctors. We also call members with multiple medical and behavioral health conditions to help coordinate their care. And we are there for the members who call our 24-hour nurse hotline with questions.
On a typical day, we provide “life preservers” to needy members, helping them find their way to safety. Although our staff is small in number, our capacity to help is enormous and our successes are countless. Whether it is helping a member get a much-needed medication, getting medical equipment items approved, helping schedule appointments, arranging transportation to appointments, or providing education, the RROT is just a phone call away. We are navigators, helping our members maneuver their crafts through the vast and complicated health care system, dealing with all types of obstacles in their way at any given time.
One of my recent success stories includes a member with end-stage cancer. I helped this member get a non-formulary medication, complete the prior authorization process to see an out-of-network provider in another state, and get a wheelchair. The wheelchair was a request from his mother because he was very weak but wanted to go to a party with his friends. I got him the wheelchair and he went to the party and had a great time. This member recently succumbed to his disease but I am very glad that I was able to bring a little comfort to him in his last days.
The RROT is only one of the many vessels that comprise the Keystone Mercy fleet. We have a multitude of professionals in the company advocating for patients and addressing their needs with compassion, dignity and respect. When the urgent issues are resolved, we offer each member a permanent case manager who will follow them throughout the rest of their journey. The case managers make regular outreach calls to their members and continue to provide the quality care on which our members depend, including disease management, reminders when there are gaps in their care, and directing them to the proper course of action toward a healthier life. The Keystone Mercy “flagship” has been afloat for over 20 years and has touched hundreds of thousands of lives on its voyage, with many successful health outcomes along the way. I am fortunate and privileged to be a part of the crew on this wonderful journey.
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