How to plan a proactive case management program
Set goals and objectives far in advance
The key to a successful proactive case management program is planning ahead, says Mary Beth Newman, MSN, BC, A-CCC.
Newman, senior project manager for case management at Anthem BCBS Midwest in Mason, OH, was on the multidisciplinary planning team that designed such a project.
She advises other organizations that may be thinking of shifting to proactive case management to have the goals, aims, and objects decided upon in advance to help keep the process moving along in a timely fashion.
Here are some other tips from Newman and Alena M. Baquet-Simpson, MD, medical director, state of Ohio, Anthem Blue Cross and Blue Shield Midwest, who was the champion on the core project team:
- Make sure you have commitment from your senior business team. The process is time-consuming, and there has to be a commitment for the personnel hours it will take.
- Make sure you have a champion within your organization. "This is more than just having a sponsor sign off on the project. Someone from the management team should be actively involved," Newman suggests.
- Define the scope of what you are trying to do early on and stick to it.
"If you set well-defined goals and objectives in the beginning, it’s easier to stay on track," she says.
- Make sure the whole core project team is focused and committed to completing the project in a timely manner.
- Stick with national and credible guidelines.
These help assure better outcomes and make it easier to get physician buy-in if physicians are familiar with the guidelines and the organizations issuing them, Baquet-Simpson adds.
- Make sure you include outcomes measures.
"One of the issues faced by case managers is demonstrating their value. With these members, you have multidimensional issues that include satisfaction, clinical outcomes, and economic components," Baquet-Simpson says.
3 steps to developing a proactive CM system
- Identify members who are a representative sample of the population. In the case of Anthem BCBS, the team came up with a proprietary formula based on population data.
- Begin proactive case management by applying the interventions. This includes initiating contact, assessing members’ needs using standard protocols, educating them with guidelines, helping them move through the health care system, coordinating and facilitating needed services, and regularly following up and monitoring progress.
- Obtain baseline data and reassessment data and use them to measure outcomes.
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