Medical Management Guide, 2009, Version 3.0 - Tricare

Medical Management GuideVersion 3.0Case ManagementPage 75ClassificationHealthcare Organization-Related OutcomesClinical• Standardization of care processes (establishing standards of care/case management plans).• Streamlined care processes and delineation of responsibilities.• Improved turnaround time of tests, treatments, and procedures.• Increased compliance with standards of regulatory and accreditation agencies.FinancialQuality of LifeSatisfaction• Appropriate changes in staff mix/skill mix.• Reduced cost (e.g., reduction in length of stay, reduction in or elimination of fragmentationand duplicate services).• Improved reimbursement and revenue.• Reduction in denials of claims.• Improved communication among providers and healthcare staff.• Prevention of inappropriate hospitalizations.• Reduction in inappropriate utilization of Emergency Department services.• Provision of a safe environment of care.• Provision of programs that meet patient and family needs.• Improved accessibility to care/services.• Improved staff satisfaction.• Reduced rates of burnout, turnover, attrition, and absenteeism.• Enhanced states of communication, collaboration, and teamwork among providers anddisciplines (interpersonal, interdisciplinary, and interdepartmental).Source: T Cesta, H Tahan (2003): Case Manager’s Survival Guide Winning Strategies for Clinical Practice, 2nd Edition, p. 100-103(Seminar Nurse Manager), Mosby.Fig. 20 – Example of Outcomes Classification: Healthcare Organization-RelatedFig. 21 lists examples of CM outcome measures.Measuring program outcomes allows CM to support and objectively track improvements in healthcareprocesses or any decline in patient progress. Outcome measurement enhances compliance with regulatoryand accreditation requirements and standards of practice; and reduces risk by demonstrating compliance withhealthcare quality guidelines.Cost-Benefit AnalysisCM activities can have a significant impact on an organization’s business plan. When case managers developeffective outcome measures, they demonstrate value to their MM department and the organization as a whole.