CMSA Today - Issue 5, 2012 - (Page 12)

CM Innovation Case Management Innovation and Entrepreneurship T It is truly amazing to see how many organizational shapes and sizes are out there delivering case management services. Clearly, the practice of case management is influenced by the institutions that sponsor and/or pay for medical management services. Purists may be concerned about all of the emerging case management platforms, but therein lies the excitement – dynamic platforms breed innovation. And that is one of the hallmarks of case management! The concepts of “entrepreneurship” and “case management” are not always used in the same sentence, but case managers with a vision and business goal are, in fact, entrepreneurs. Consider the many business models that foster business growth while maintaining the principles of case management and the patients they serve as the centerpieces of the organization. he primary goal of case management is to improve the clinical status of the patients that case managers serve. This applies to every case manager whether they work for a provider, health plan, government agency, or another organization. BY GARRY CARNEAL, JD, MA Healthcare gave case management a boost when it turned away from the traditional UM denial model about 12 years ago and made national headlines. In the same fashion, small regional health plans often test out new case management models, including innovative, community-based medical management systems. Provider-based Case Management Hospitals traditionally have focused on discharge planning from a case management perspective to minimize extended lengths of stay. Today, their case management bandwidth has expanded to support readmission prevention programs, longer term transition of care strategies, integrated delivery models, and other creative solutions. Some larger specialty provider organizations are doing the same thing. Again, most of these provider-based programs are driven by passionate case managers who care deeply about their patients’ well-being. Expansion of Integrated Medical Management Programs Clearly there is a trend toward case management solutions going deeper and broader to support agreed upon business and clinical goals. Julie O’Brien, senior vice president and COO for Alicare Medical Management, notes, “Full service care management organizations offer backend services to health plans and self-funded plans.” These organizations have been on the leading edge in terms of integrating a wide array of case management services. O’Brien notes that her organization offers the full range of services from UM, CM, disease management, telephonic nurse COMPANY PLATFORMS A variety of organizations support innovative platforms that rely on synergistic interfaces with quality-based, case management activities. Payor-based Case Management Health plans historically have focused on minimizing insurance risk, but over the years many examples have emerged in which senior leadership has recognized that better clinical outcomes yield financial savings. Case management-based innovation can be seen by both large and small plans. United 12 CMSA TODAY Issue 5 • 2012 • DIGITAL http://www.naylornetwork.com/cms-nxt/

Table of Contents for the Digital Edition of CMSA Today - Issue 5, 2012

Preisdent's Letter
So, You Want to Be Your Own Boss?
Case Management Innovation and Entrepreneurship
Entrepreneurship: The Less-traveled Road in Case Management
Payment Information for the Medicare and Medicaid E HR Incentive Programs
CMSA Corporate Partners
Association News
Index to Advertisers

CMSA Today - Issue 5, 2012

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