CMSA Today - Issue 4, 2016 - (Page 12)

Triple Aim Triple Aim Requires Case Management "Target" Practice BY ELLEN ALIBERTI, RN, BSN, PHN, CCM, MS N o one working in the healthcare field for any length of time has been immune to the incremental shift from volume-based to value-based care delivery. There are many factors behind this significant change, yet at the very core was a growing concern about the escalating cost of healthcare coupled with modest health outcomes. In a report dated Aug. 20, 2015, the World Health Organization noted that 10% of the gross domestic product (GDP) was spent on healthcare in 2013; or, in other words, $2.9 trillion on national health expenditures.1 In the U.S., our government leaders are projecting that by 2024, nearly $1 of every $5 spent will be on healthcare. They reference several reasons, including the expansion of the number of consumers with health insurance due to Obamacare; increases in prescription spending with the advancements in biologics and cancer treatments; improved U.S. economic growth and the unparalleled growth of our older Americans transitioning to Medicare.2 And yet, despite the fact that have the most expensive healthcare system in the world, we rank behind most countries on many measures of health outcomes, quality and efficiency.3 As a nation, we collectively understand we need to do better; as case managers we also understand how do to it better. Our key focus since the earliest days of our practice development has been on ensuring quality of care, improving health outcomes and reducing cost. So, it is really no surprise that the practice of case management continues to be the nucleus of many highly integrated healthcare delivery organizations such as Kaiser, Group Health Cooperative and Davita Healthcare Partners. Therefore, as the Institute 12 CMSA TODAY Issue 4 * 2016 of Healthcare Improvement (IHI) puts forth its model of care for improving our nation's healthcare system, case management continues to be integral to our success. IHI insists that in order to be successful we must simultaneously pursue three objectives, which it refers to as the "Triple Aim." They include: 1. Improving the experience of care 2. Improving the health of populations 3. Reducing the per capita cost of care4 Let us explore each of these three objectives in relation to the practice of case management. IMPROVING THE EXPERIENCE OF CARE This aim involves two distinct aspects of care-the quality of care and the consumers' satisfaction with the care they received. The case management assessment process entails a thorough review of the treatment plan to ensure that evidence-based care is being delivered. Our practice also involves ongoing evaluation of patients' level of adherence, knowledge of disease or condition and capability to manage self-care. Case managers are adept at facilitating care coordination across the continuum to ensure seamless care transitions. The CM process often includes ensuring that medical records are available to specialists and sites of care; follow up that appointments are scheduled and attended; and adequate communication among all stakeholders concerning the treatment plan and their accountabilities in care delivery. Additionally, by virtue of the fact that the CM process includes monitoring of the patient's care plan, we can readily influence patient satisfaction by ensuring responsiveness to any knowledge deficits or gaps in care. "Case management practice strongly endorses the notion that individuals are the experts in their health matters and we must partner with them in making healthcare choices." IMPROVING THE HEALTH OF POPULATIONS This aspect of care is centered on the need for healthcare systems to have the capability to improve the overall health of the populations they serve. In other words, our healthcare delivery must be responsive to the needs of all patient cohorts we serve, including health promotion and health maintenance screenings and disease-specific evidence-based treatment and education. This measure's success is largely dependent on two factors: 1. Healthcare providers' vigilance to overall health maintenance screenings and standard of care for key diseases or conditions (i.e., DM, COPD, CHF, CKD). 2. Active patient engagement. Patient advocacy has been an essential attribute of case management practice

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2016

President’s Letter
Association News
CMSA Corporate Partners
Triple Aim Requires Case Management “Target” Practice
Finding the “Right” Care Management System: “Must Have” Requirements + Structured Demonstration Process
Understanding the Health Insurance Appeals Process for Case Managers
Keeping the “Professional” in Professional Case Management
Patients Get Better Care When Doctors, Hospitals and Insurers Share a Common Interest
Index of Advertisers

CMSA Today - Issue 4, 2016