Part One: Basics of Case Management, Five-Part Series-Basics of Case Management Series, Part 1 Recording

Video Transcription

Video Summary

In this session, Dr. Toni Sesta, founding partner of Case Management Concepts, LLC, presents an overview of evolving healthcare case management models. Case management aims to provide quality, safe, and cost-effective care, with Dr. Sesta elaborating on various payment methodologies, the significance of hospital and community case management, and the ever-evolving bundled payment and accountable care organization (ACO) models.<br /><br />Dr. Sesta highlights that effective case management requires integrating care across various settings and ensuring patient needs and goals are addressed. Case managers, who are crucial in promoting resource utilization and achieving clinical and financial outcomes, need to be well-versed in new payment models like bundled payments and ACOs. These models push case managers to think beyond hospitals, stressing the importance of coordination with community care providers to reduce readmissions and improve overall care quality and patient satisfaction.<br /><br />The webinar discusses the changes in health care reimbursement, including the transition from traditional models to value-based care. Dr. Sesta sheds light on the implications of bundled payment models, focusing on joint replacements and highlighting the efficiencies and improved care transitions and coordination they aim to facilitate.<br /><br />Touching upon the challenges and solutions in managed care and Medicare Advantage plans, Dr. Sesta stresses the significance of case management as a strategic function in hospitals. Participants are encouraged to collaborate and align with community resources to optimize patient outcomes and are reminded to remain informed about evolving healthcare policies and methodologies. <br /><br />Additionally, Dr. Sesta underscores the importance of health literacy in patient care and the role of case managers in bridging communication and service gaps to enhance patient self-management and adherence. Lastly, she provides insight into the growth and integration of community case management strategies aimed at high-risk, high-cost patient populations.

Keywords

case management

healthcare

Dr. Toni Sesta

payment methodologies

bundled payments

accountable care organizations

ACO models

resource utilization

value-based care

Medicare Advantage

health literacy

community care

patient self-management

care coordination

clinical outcomes