CMSA Today - Issue 3, 2018 - 20

PRIMARY CARE

CASE MANAGEMENT IN
PRIMARY CARE
MAKES A DIFFERENCE
BY PAM AUDISH, BSN, RN, CCM

CASE MANAGEMENT IN PRIMARY
CARE MAKES A DIFFERENCE
The relationship between a patient and
provider isn't singular; rather, it is a relationship between the patient and an entire
practice. Without the patient engagement
team, which is quite often led by a primary
care case manager (PCCM), a patient can
fall through the cracks.
As an example, a 78-year-old female
patient schedules an appointment with her
primary care physician to get her diabetic
medications refilled but doesn't show for
the appointment. The patient runs out of
medications and ends up in the ED with
hyperglycemia, where she receives a new
prescription and is discharged home - an
expensive and unnecessary step that the
patient care team, led by a case manager,
should prevent.
The case manager collaborates with
primary care to provide effective management of high-risk patients and improvement
of their quality of life. Avoidable ED visits
and medication adherence are two specific healthcare measures that PCCM can
improve. Case management opportunities
in primary care are growing, in large part
due to value-based contracting.

situations, admissions for ambulatory care
sensitive conditions and all-cause readmissions. PCCM may be provided through an
embedded model, as described by Hines
and Mercury in Designing the Role of the
Embedded Care Manager (2013), or through
a telephonic model. A PCCM provides care for
populations in various value-based contracts.
These may include commercial, Medicare
Advantage, Medicare Shared Savings Program
and Medicaid populations. While providing
the essential functions of case management,
the case manager has knowledge of resources
in the community, plus resources available

ROLE OF THE PRIMARY
CARE CASE MANAGER
Case managers collaborate with primary
care to provide care to patients who are predicted to create high costs associated with
poor quality and avoidable care: those with
frequent ED utilizations for non-emergency
20

CMSA TODAY

Issue 3 * 2018 * DIGITAL

through the payer. Case managers identify
quality measure gaps for each patient as closing gaps in care is an important measurement
of success in value-based care. In addition, the
case manager collaborates with health plan,
facility and ancillary provider case managers
as the patient receives care throughout the
continuum.
OUTCOMES OF CASE
MANAGEMENT IN PRIMARY CARE
Case management in primary care can
reduce hospitalization, decrease healthcare
costs and improve physician and patient

SOURCE:INNOVISTA



Table of Contents for the Digital Edition of CMSA Today - Issue 3, 2018

President’s Letter
Association News
CMSACorporate Partners
The Opioid Epidemic: Understanding the History and Confronting the Impact Today
Accountable Care Organizations and the Impact on Care Management
Case Management in Primary Care Makes a Difference
Past Presidents Corner
The Integrated Case Management Program: Essential for Today’s Case Manager
Index of Advertisers
CMSA Today - Issue 3, 2018 - Intro
CMSA Today - Issue 3, 2018 - cover1
CMSA Today - Issue 3, 2018 - cover2
CMSA Today - Issue 3, 2018 - 3
CMSA Today - Issue 3, 2018 - 4
CMSA Today - Issue 3, 2018 - 5
CMSA Today - Issue 3, 2018 - 6
CMSA Today - Issue 3, 2018 - President’s Letter
CMSA Today - Issue 3, 2018 - Association News
CMSA Today - Issue 3, 2018 - 9
CMSA Today - Issue 3, 2018 - 10
CMSA Today - Issue 3, 2018 - CMSACorporate Partners
CMSA Today - Issue 3, 2018 - The Opioid Epidemic: Understanding the History and Confronting the Impact Today
CMSA Today - Issue 3, 2018 - 13
CMSA Today - Issue 3, 2018 - 14
CMSA Today - Issue 3, 2018 - 15
CMSA Today - Issue 3, 2018 - 16
CMSA Today - Issue 3, 2018 - 17
CMSA Today - Issue 3, 2018 - Accountable Care Organizations and the Impact on Care Management
CMSA Today - Issue 3, 2018 - 19
CMSA Today - Issue 3, 2018 - Case Management in Primary Care Makes a Difference
CMSA Today - Issue 3, 2018 - 21
CMSA Today - Issue 3, 2018 - 22
CMSA Today - Issue 3, 2018 - Past Presidents Corner
CMSA Today - Issue 3, 2018 - 24
CMSA Today - Issue 3, 2018 - 25
CMSA Today - Issue 3, 2018 - The Integrated Case Management Program: Essential for Today’s Case Manager
CMSA Today - Issue 3, 2018 - 27
CMSA Today - Issue 3, 2018 - 28
CMSA Today - Issue 3, 2018 - 29
CMSA Today - Issue 3, 2018 - Index of Advertisers
CMSA Today - Issue 3, 2018 - cover3
CMSA Today - Issue 3, 2018 - cover4
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