CMSA Today - Issue 7, 2017 - 16

"The increase in our aging population, coupled with the
continued progress in the shift away from fee-for-service
payments, means more lives will be overseen by care teams
than ever before in the coming decade. Care organizations
must look comprehensively at existing case management
protocols and tools and consider how they can be improved
upon to meet their needs."
on how recently the last home visit took
place. Hand-written notes taken by each
care team member aren't typically traded.
What's more, you know that the most
important person in the patient's life is not
you, or the nurse, or the physician, but her
daughter who cares for her on a daily basis.
Yet the daughter isn't invited to join the
conference calls and you struggle to get in
touch with her by phone because her day
job keeps her busy during business hours.
As easy as texting might seem to be as a
solution to get around this challenge, you
know SMS is not HIPAA-compliant, so your
use of it is limited to scheduling visits, not
discussing important topics related to the
patient. Plus, even if you could use texting, it would be very difficult to use these
exchanges in patient-centered care planning due to a lack of organization.
Even someone who's not a case manager
can see that this situation is not optimal.
Members of a care team ought to be able to
communicate with each other at any time,
as conditions and circumstances change for
the patient. They should have a record of
these communications that can be referenced at a later date, so nothing is forgotten. And as the most proximate person to
the patient, the family caregiver, should be
part and parcel of the interdisciplinary care
team, not separate from it.
The urgency to solve for these inefficiencies is growing as payers and providers, particularly new accountable care
organizations, turn to home- and community-based case management to improve
outcomes among their patients in line with
16

CMSA TODAY

fee-for-value incentives. The increase in our
aging population, coupled with the continued progress in the shift away from fee-forservice payments, means more lives will be
overseen by care teams than ever before
in the coming decade. Care organizations
must look comprehensively at existing case
management protocols and tools and consider how they can be improved upon to
meet their needs. Quality case management
in the community will be foundational to
their efforts to improve outcomes.
Sadly for organizations eager to find
quick solutions, there is no magic bullet for driving efficiency in home-based
case management. But there are a few
emerging tenets based on the work of
pioneering organizations in this field. The
most successful organizations leverage a
combination of caregivers from outside
the traditional care team (family members
and friends), protocols that define clinical
focus for the care teams to prevent adverse
events, and technology.
Beginning with technology, it must be
stressed that its potential is limited without
other key aspects of case management,
particularly human touch. Case managers
cannot be replaced by robots. It's important
to remember that the key to case management lies in enabling the people on the care
team, not in minimizing them.
In fact, as Ezekiel Emanuel put it in his
recent book Prescription for The Future, The
Twelve Transformational Practices of Highly
Effective Medical Organizations, "Offices
and health systems that have made chronic
care management work do not necessarily

Issue 7 * 2017 * DIGITAL

deploy lots of technology such as continuous
glucose monitors, continuous heart monitors, high tech pill dispensers and remote
camera monitoring. They instead rely on
human-to-human contact and lots of it -
from everyone on the healthcare team."
This isn't to say that better technology
can't help. Given the inherent inefficiency
of telephone calls (just a 20-percent reach
rate on average for care teams) and the
insecurity of SMS messages, new tech is
actually a necessity for finding efficiency.
But it should be built with the needs of the
care team in mind. While modern technology already drives the systems that many
organizations use to centrally organize and
store information for the long term, it has
not reached the point of becoming a constant collaboration interface on a minuteto-minute basis for those in the field, on
the front lines. The opportunity is there for
technology to extend from the center to
"the edge." This extension will become all
the more essential as organizations move
away from a transactional focus toward
patient-centered care planning.
In order to reach such a stage, technology should promote the transfer of information in a way that benefits the care team
members and the patient. This sounds
obvious, but considering the overwhelming caseloads managers often deal with,
and the many failed experiments to date
in introducing new software across parts
of the healthcare system, special care must
be taken to avoid having technology add
to the stress. How easily new and different
technology can become a burden to those
using it is something that is too often forgotten by developers of technology with
little experience in the day-to-day grind of
care management.
Any new technology should connect
users in a way that effortlessly replaces
time-consuming tasks with no inherent
value and removes redundancy from the
process. Think of a case manager placing
individual phone calls to notify all care team
members of a change in patient condition,
rather than sending one message to all
simultaneously. Or making several unsuccessful attempts to connect by phone with



Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2017

President's Letter
Association News
CMSA Corporate Partners
Care Transitions: Remember the Basics
Leveraging Family Caregivers, Clinical Protocols and Technology to Improve Person-Centered Care
Development and Implementation of Relational Building in the Virtual Work Environment
Patient and Provider Satisfaction
The Case Management Model Act: Professional Case Managers Transforming Health Care
Index of Advertisers
CMSA Today - Issue 7, 2017 - Intro
CMSA Today - Issue 7, 2017 - cover1
CMSA Today - Issue 7, 2017 - cover2
CMSA Today - Issue 7, 2017 - 3
CMSA Today - Issue 7, 2017 - 4
CMSA Today - Issue 7, 2017 - 5
CMSA Today - Issue 7, 2017 - President's Letter
CMSA Today - Issue 7, 2017 - 7
CMSA Today - Issue 7, 2017 - Association News
CMSA Today - Issue 7, 2017 - 9
CMSA Today - Issue 7, 2017 - CMSA Corporate Partners
CMSA Today - Issue 7, 2017 - 11
CMSA Today - Issue 7, 2017 - Care Transitions: Remember the Basics
CMSA Today - Issue 7, 2017 - 13
CMSA Today - Issue 7, 2017 - 14
CMSA Today - Issue 7, 2017 - Leveraging Family Caregivers, Clinical Protocols and Technology to Improve Person-Centered Care
CMSA Today - Issue 7, 2017 - 16
CMSA Today - Issue 7, 2017 - 17
CMSA Today - Issue 7, 2017 - Development and Implementation of Relational Building in the Virtual Work Environment
CMSA Today - Issue 7, 2017 - 19
CMSA Today - Issue 7, 2017 - Patient and Provider Satisfaction
CMSA Today - Issue 7, 2017 - 21
CMSA Today - Issue 7, 2017 - The Case Management Model Act: Professional Case Managers Transforming Health Care
CMSA Today - Issue 7, 2017 - 23
CMSA Today - Issue 7, 2017 - 24
CMSA Today - Issue 7, 2017 - 25
CMSA Today - Issue 7, 2017 - 26
CMSA Today - Issue 7, 2017 - 27
CMSA Today - Issue 7, 2017 - 28
CMSA Today - Issue 7, 2017 - 29
CMSA Today - Issue 7, 2017 - Index of Advertisers
CMSA Today - Issue 7, 2017 - cover3
CMSA Today - Issue 7, 2017 - cover4
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