What is results-driven case management?
Three questions can help pinpoint CM’s value
By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR
Everyone wants a good outcome from case management services, but not everyone knows what the result should be or how to measure it.
Three fundamental questions can be used to pinpoint the value of case management. The first question is "What results should we get?" This question is about figuring out what you want to achieve with case management services.
The second question is "How well are we doing?" This question is about actually doing the work and measuring or monitoring to see how you are doing.
The third question is "What must we do to ensure that we get results?" This question is about managing the activities of the department to stay on track toward desired goals and about taking corrective action when there is a gap between planned and actual results.
• What results should we get?
This question guides the activities of the case management department. It can be a very difficult question, because it must take into account many unknowns about the environment: What could the case management department do that would benefit the organization, patients and their families, physicians, and other caregivers? If "What results should the organization get?" has been adequately answered at the senior leadership level, it is easier to answer at the operational level of case management.
Given the leadership direction, set in terms of the organization’s strategic goals, policies, and budgetary constraints, the case management department director can specify "What results should we get?" within the department’s sphere of influence.
This is done by determining what the department should accomplish to achieve the organization’s strategic objectives. Similarly, individual case managers can figure out a good answer to the question "What results should I get?" if each has clear answers at the department level as a beginning point.
Absent such clarity, people at every level are left to guess about what should be happening and, perhaps, pursue individual agendas.
• How well are we doing?
This question is about the current state of case management services — the timeliness, quality, and cost of operations. At the level of the individual case manager, it is about completion of responsibilities and tasks. The question is answered in terms of actual work performance. "How well are we doing?" is about execution of the plan intended to achieve desired results.
• What must we do to ensure we get the results?
The first two questions are about planning and execution of case management services. The third question is about managing case management activities to achieve goals. It is about directing case management resources and tools toward desired results. It also is about making modifications when case management performance and expectations do not match. Results-driven case management requires pinpointing the performance that will enhance organizational results, translating those performance expectations into case management goals and interventions, and then measuring progress toward desired results.
Here is an example of how results-driven case management can be applied to a hospital’s strategic goal of improving care and reducing costs for patients with diabetes: Senior leaders determine that improving care for patients with Type I diabetes is a strategic goal for the organization. Four related objectives are defined and measures of success identified. (See chart.)
Achieving the hospital’s strategic goal and objectives requires the involvement of many different professional disciplines, including case management. To determine the role of case managers in achieving these strategic objectives, the case management director first considers, "Within our sphere of influence, what should we be able to do to assist in achieving the results desired by the organization?"
For each of the organization’s objectives, one or more important case management tasks are identified. When selecting important case management tasks, the director considers the core functions — assessment, planning, facilitation, monitoring — and the overall measures of success chosen by the organization. For example, to assist in reducing utilization of hospital services, the case managers can actively monitor the appropriateness of patients’ continued stays in the critical care unit.
Timely intervention by case managers can help facilitate patient transfers to a general unit when critical care is no longer needed. The director conducts a similar questioning process for each strategic objective.
Once the case managers’ contributions toward achieving strategic objectives are identified, then the director determines how this contribution will be measured. How well are case managers doing at meeting these performance expectations? Each important case management task is monitored. The performance measures provide a quantitative answer to the question, "How well are we doing?"
For example, if an important case management task is timely intervention when patients with diabetes no longer require critical care services, the performance measure would be: Percentage of cases in which the attending physician is contacted by a case manager within 24 hours of the patient no longer needing critical care services.
If early case management intervention is felt to be a critical factor in reducing the length of hospital stays for patients with diabetes, then the measure of case management performance would be: Percentage of patients admitted for treatment of Type I diabetes or related conditions that receive an initial case management assessment within 24 hours following admission.
The last step is to monitor compliance with important case management tasks. This involves collection and analysis of performance measurement data to determine if expectations are being met. This information affords insight into how well case managers are completing the tasks needed to assist the organization in achieving strategic goals and objectives. If important case management tasks are not getting done as expected, further investigation is needed. A trend of noncompliance influences the sense of urgency for analysis and action. The focus is on identifying the variables affecting less than desired performance and what can be done by the case management department to recover from the shortfall.
Performance monitoring is about keeping case management activities on track toward achieving organizational goals, not assigning blame for what is happening. If a case manager is performing incompetently, modifying that individual’s performance would be part of corrective actions required. However, assigning blame, by itself, does little to modify overall departmental performance in a positive direction.
The case management department can best communicate to senior leaders that they are getting a return on their investment by linking the organization’s strategic goals and objectives to case management activities. By evaluating case management results through the common lens of the goals established by senior leaders, the contribution of case management becomes easier to communicate. Most important, case management performance measurement results will provide timely, relevant, and concise information that can be used by decision makers — at all levels — to assess progress toward achieving important organizational strategies.
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