Areas of Optimal Case Manager Effectiveness
May 1, 1999
Areas of Optimal Case Manager Effectiveness
Reducing costs
• Avoiding test/consult delays
• Avoiding prolonged use of IV antibiotics
• Decreasing inappropriate high-cost lab, radiology, pharmacy, and other medical orders
• Avoiding unauthorized treatments
• Expediting discharge process on admission to prevent increased LOS
• Negotiation with payers to maximize patient funds
• Suggesting alternative treatment plans/appropriate level of care
• Monitoring costs
Enhancing quality clinical outcomes
• Synthesizing other disciplines’ assessment findings and completing an expanded assessment of the patient’s and family’s needs on admission
• Teaching patients and families prior to, during, and post-discharge
• Coordinating the multidisciplinary team under the direction of the MD to promote achievement of desired patient outcomes
• Monitoring patients’ progress toward expected outcomes
• Anticipating an emerging problem and acting quickly to manage an evolving clinical picture
• Preventing patient, practitioner, and system variances when possible
• Monitoring, tracking, and analyzing aggregate complex patient population quality data to improve process/outcomes of care
Enhancing patient, family, and provider satisfaction
• Assist patient in understanding treatment choices, alternatives, benefits, and risks
• Orchestrate the "system" for the patient
• Work with health care team to ensure that patient and family are fully informed and in agreement with the plan of care
• Provide 24-hour on-call availability to MD, patient, and health care team
• Establish working relationships with referral sources
• Communicate to other health care providers as appropriate to coordinate patient care
• Discuss patient’s and family’s satisfaction with them, and respond to complaints appropriately
• Monitor, track, and analyze satisfaction data
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