Part Three: Beyond Basics of Case Management Five-Part Series (ODW5012PT3)-2025 Beyond Basics Case Mgt Part 3 Presentation

2025 Beyond Basics Case Mgt Part 3 Presentation

Pdf Summary

The document titled "Case Management Beyond Basics Boot Camp" by Toni Cesta, PhD, RN, FAAN, provides an in-depth exploration of the evolving roles within case management in healthcare, emphasizing the integration and collaboration between case managers and physician advisors. It highlights key stakeholders involved in effective case management, including nursing staff, social workers, medical officers, hospitalists, and physician advisors, and underscores the necessity of aligning these roles to ensure optimal patient care.<br /><br />The role of the Physician Advisor (PA) is particularly examined, detailing its alignment with the goals of the Affordable Care Act to deliver the right care without unnecessary delays or costs. As physician advisors become more integrated into quality management and regulatory compliance, their collaboration with case management leaders is highlighted as key to achieving improved healthcare outcomes, like effective resource utilization and patient safety.<br /><br />Additionally, the American College of Physician Advisors and other organizations provide support and resources for the PA role, demonstrating its importance in hospitals' strategic and operational frameworks. The document outlines how Physician Advisors contribute to utilization management, compliance, care transitions, and payer negotiations, emphasizing the necessity for a comprehensive job description and clear understanding of their potential impact.<br /><br />Challenges faced by PAs, including underutilization and lack of collaboration with medical staff, are discussed. The text also addresses the roles of hospitalists and emergency department physicians in case management, examining their interactions and the challenges of ensuring effective communication and coordination across different hospital departments.<br /><br />Specialty case management roles like discharge planning specialists and peri-operative case managers are introduced to streamline operations and support effective patient care. The document concludes with strategic insights into how case management departments can work with physicians to enhance healthcare delivery, thus reflecting on both past developments and future directions in this critical area of healthcare management.

Keywords

Case Management

Physician Advisor

Healthcare Collaboration

Affordable Care Act

Resource Utilization

Patient Safety

Utilization Management

Compliance

Care Transitions

Healthcare Delivery