Part Five: Basics of Case Management, Five-Part Series-Basics of Case Management Series, Part 5 Recording

Video Transcription

Video Summary

The video features Dr. Toni Sesta, a founding partner at Case Management Concepts, LLC, discussing the integration and optimization of roles within hospital case management through the series' final module. Dr. Sesta, bringing over 25 years of research and experience, explores various roles critical to effective case management, such as patient flow, utilization and resource management, and the importance of discharge planning. She emphasizes the importance of delineating specialized roles within case management to leverage the specific skill sets of RNs and social workers. Dr. Sesta also discusses the emerging focus on psychosocial assessments and interventions which are increasingly crucial in case management, aligned with CMS (Centers for Medicare & Medicaid Services) guidelines. The session underscores the transition to using tools like the Social Drivers of Health questionnaire and integrating Z codes to optimize reimbursements and patient outcomes. Audience members are encouraged to be aware of the forthcoming CMS regulations impacting reimbursement tied to social health assessments. Finally, Dr. Sesta advises on choosing either the integrated or collaborative case management models based on organizational capacity and needs, warning against creating untested homegrown models. The session wraps up by encouraging team members to reach out for additional questions, highlighting the importance of adaptability and informed practice in maintaining compliance and optimizing patient care and management efficiently.

Keywords

Dr. Toni Sesta

Case Management Concepts

hospital case management

patient flow

resource management

discharge planning

RNs and social workers

psychosocial assessments

CMS guidelines

Social Drivers of Health

Z codes

reimbursement

integrated case management

collaborative case management