Part Four: Beyond Basics of Case Management Five-Part Series (ODW5012PT4)-2025 Beyond Basics Case Mgt Part 4 Presentation

2025 Beyond Basics Case Mgt Part 4 Presentation

Pdf Summary

The document presents an extensive exploration of case management within the continuum of care, authored by Toni Cesta, PhD, RN, FAAN, of Case Management Concepts, LLC. It spans various healthcare settings including primary care, ambulatory care, acute care, rehabilitation, and home health, emphasizing the concept of an integrated system of care that manages patient care over time through comprehensive health services.<br /><br />The significance of case management as an integrating mechanism within the continuum of care is highlighted. It stresses that effective case management not only reduces healthcare costs through mechanisms like bundled payments and accountable care organizations (ACOs) but also improves the quality and transition of care across different healthcare settings. The document details various care settings such as hospitals, skilled nursing facilities, and home care, each carrying distinctive cost implications and challenges.<br /><br />The Centers for Medicare & Medicaid Services (CMS) are heavily emphasized, with discussions on payment models like bundled payments and Medicare Spending Per Beneficiary (MSPB), which are designed to encourage efficient care transitions and reduce hospital readmissions. Furthermore, the document outlines the role of case managers in facilitating seamless transitions and their responsibilities including advocacy, coordination, and managing patient education.<br /><br />The document also outlines numerous influences on patient transitions including payer regulations, hospital issues, and patient-family dynamics, and suggests solutions such as community-based case management and effective handoff protocols to mitigate potential issues.<br /><br />Throughout the document, the future of case management is envisioned as a holistic approach spanning across healthcare settings, integrating technology, and forming collaborative networks to enhance patient outcomes, reduce readmissions, and manage healthcare resources efficiently. It also provides resources and contact information for further support in healthcare management and caregiving.

Keywords

case management

continuum of care

integrated system

healthcare settings

bundled payments

accountable care organizations

care transitions

Medicare Spending Per Beneficiary

patient advocacy

community-based case management