The addition of care management assistants to the care management team at Spectrum Health Grand Rapids hospitals has contributed to work flow efficiencies, compliance, interdisciplinary teamwork, and smooth transitions of care, says Britt Thompson, MSN, RN, clinical manager of care management at Spectrum Health, a Grand Rapids, MI, health system.
Instead of asking for more licensed staff when new requirements from payers and an increase in the acuity of inpatients added more responsibilities for care managers, the care management department asked the health system’s administration for care management assistants.
The administration appointed a person who was working as an insurance coordinator to the newly created position of care management assistant and asked her to try the job for six months as a pilot project. By the time the pilot project was drawing to a close, two more care management assistants were on staff, Thompson says.
The health system now has 10 care management assistants who work at three hospitals: Blodgett Hospital, Butterworth Hospital, and Helen DeVos Children’s Hospital. The original staff member is still working as a care management assistant.
“With healthcare reform, we are experiencing a tsunami of new and changing regulations from the Centers for Medicare & Medicaid Services and changes in hospital reimbursement, along with an increase in our case mix index but we still are operating with the same caseloads as 10 to 15 years ago. Our care managers have a caseload of about 22 patients. There is no way we could function without support from the care management assistants,” adds Tal Harris, MSN, RN, ACM, supervisor of care management at Spectrum Health/Blodgett Hospital.
In the beginning, the care management assistant went from unit to unit asking the care managers if they needed any help with faxing, copying, calling the insurance company, and other tasks that do not require a license.
Now care management assistants are assigned by unit and typically assist care managers and social workers on four or five units, depending on the unit size.
The care management assistant program is very structured, Harris says. Each morning, the care managers delegate tasks to the care management assistants through the department’s software. All of the care management assistants meet every morning at 8 a.m. to discuss their caseloads and to make sure all of the units are covered.
“The care management assistants work as a highly functioning team and cover for each other when needed,” she says.
The specific tasks vary according to the units on which the care management assistants work. They help identify primary care physicians for high-risk patients who don’t have one, line up transportation, and help with ordering durable medical equipment.
The care management assistants verify with the courts that patients have guardianships within 24 hours of admission and enter the information in the electronic medical record to make the staff aware. They also facilitate the completion of Medicare’s required Face-to-Face form that certifies a patient’s need for home care and deliver the Important Message from Medicare to patients.
The care management assistant who works on the women’s health floors (labor and delivery, obstetrics, post-partum) informs new mothers about community programs for mothers and babies, and facilitates referrals to the programs. In the pediatric hospital, they help parents fill out the paperwork for a State of Michigan program that supplies lodging and meals so parents of pediatric patients covered by Medicaid can stay nearby when their child is in the hospital.
Having care management assistants helps the department align with the healthcare organization’s systemwide goals that include compliance with changing and new CMS regulations, efficient and lean work, role satisfaction, and tightening the budget, Thompson says.
“The addition of care management assistants have contributed to workflow efficiencies, to compliance, to interdisciplinary teamwork, and to smooth transitions. Our goals for the program are to allow licensed disciplines to practice patient-centered care and practice at the full scope of their professional licenses and to facilitate safe, smooth, and efficient transitions of care,” Harris says.
Initially, some of the licensed staff were reluctant to turn some of the tasks over to the care management assistants, Harris says.
“We had a lot of conversations with them and are still prompting them occasionally to let the assistants do what they were hired to do. Some nurses and social workers still hesitate to turn over some tasks to other people but for the most part, the licensed staff has seen that the care management assistants are reliable and have learned to trust them,” Harris says.
The care management assistants are required to have a two-year degree and experience in the healthcare arena, but the majority are college graduates.
“The position is a great entry level for college graduates who want to get into healthcare in a non-clinical way,” Thompson says. One assistant worked through graduate school and has transferred into the health system’s quality department. Another completed a graduate degree in social work and is working for the health system as a social worker.
New care management assistants go through an orientation process that varies depending on the unit to which they are assigned. Orientation includes completing a validation tool and partnering with a preceptor who helps them work toward competency in required skills. When they go out on their own, they have the support of a mentor who can answer any questions.
Accountability is built into the structure of the program. The design team developed well-defined role expectations and processes and provide constant feedback during the learning process, Harris says.
For instance, the team posts a weekly overall report of compliance with Medicare’s requirement to give patients the Important Message from Medicare and measures individual performances to identify “star performers.” More experienced assistants coach the new staff on what they should do, and the whole department celebrates improvements.
When Medicare began requiring the Important Message from Medicare, the hospitals’ compliance levels were very low, Harris says. Today, better than 99% of the notices are successfully delivered.
Before the program started, representatives from the care management department approached the leadership team and talked about all the tasks they were doing that didn’t require a license. “We talked about how having care management assistants would maximize the skills and education of the nurses and social workers who could concentrate on the jobs that require their expertise and not be burdened with clerical tasks,” Thompson says.
“It was easy to show the benefit to leadership. The assistants’ salaries were much less than the nurses and social workers were getting. With assistants, the licensed staff could spend their time working on complex cases rather than being on hold with an HMO or doing other things that don’t require a license,” she says.
The care management team made the case for assistants by pointing out the similarities in a care management assistant and a nursing aide. “We told them that they don’t want the bedside nurse bathing and toileting patients. At the same time, we don’t want the care managers tied up on the phone with the insurance company or faxing documents to post-acute providers,” Harris says.
Harris suggests that case management departments start small with one or two assistants and expand as they determine what works best in their hospital.
She cautions about letting care management assistants cross the line between their jobs and standard nurse case manager or social worker tasks.
For instance, care management assistants should not be asked to talk with families about choosing post-discharge destinations or to deal with difficult patients. “They never should be asked to perform an assessment of a patient or do anything else that requires a higher level of critical thinking,” she says.
The addition of care management assistants to the care management team at Spectrum Health Grand Rapids hospitals has contributed to work flow efficiencies, compliance, interdisciplinary teamwork, and smooth transitions of care.
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