Transforming case management in healthcare
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From toggling tediously between systems to achieving whole-person care

The rationale behind transforming case management in healthcare

Case management impacts all aspects of a patient's healthcare journey, from understanding care options and finding the right physician to having a clear picture of the financial costs. But today, case management is more about tracking a patient from one point of service to another rather than having a comprehensive view of a person's health.

Many health providers must work with and rely on piecemeal systems, making it almost impossible to get a holistic view of a person's health history with an individual clinician, let alone across an entire healthcare system. This means providers often have incomplete snapshots of a patient's medical record rather than a full picture that includes any community resources they might have also accessed.

But it doesn't have to be this way. By adopting a single engagement platform, providers can elevate the role of case management from one that does more than simply monitor a patient's movements through the care system. With a more connected approach, they can:

  • Give clinicians visibility when patients receive care from other parts of the healthcare system
  • Consolidate and access data from different sources, giving relevant information at the right time
  • Automate processes and standardize treatment protocols
  • Include patient preferences, social determinants of health, and health equity data in medical records for better patient engagement and education
  • Accelerate the shift to value-based care rather than the prevailing fee-for-service model based on the number of procedures and services a provider performs

Juggling siloed systems and escalating health risks

With a patchwork of siloed systems, clinicians must painstakingly toggle between screens to access a patient's medical record and capture new data. Entering information manually in separate systems prevents clinicians from fully engaging with patients. And while it's also tedious and inefficient, these extra steps have a deeper impact.

Juggling multiple platforms makes it difficult for a clinician to digest a patient's complete medical history. It also prevents providers from identifying an escalating health condition or causes them to miss critical information that could redirect care decisions.

Disparate systems also add to a clinician's administrative workload, which limits their ability to practice at the top of their license and provide direct patient care. This extra work can, in turn, have a detrimental effect on a clinician's mental health and exacerbate burnout. A 2021 National Library of Medicine study found that 70% of physicians with electronic health records (EHR) reported health IT-related stress.

Bethlyn Gerard is director of advancing care excellence for Southwestern Health Resources. The healthcare system cares for nearly 800,000 people across North Texas in its 31 hospitals and 650 facilities and clinics. Gerard's team helps its providers deliver high-value care.

She says that in its current form, "Care management is really a series of handoffs across the care continuum. It's patients with complex needs going from one point of service to another point of service."

And because primary, specialty, and acute care providers often don't have access to the same information, they all have a fragmented view of a patient's health history. As Gerard says, "There's not a 'grand round' across the whole patient journey."

Connecting all points with a single system

With a single case management platform, providers and healthcare systems can connect and integrate with a person's EHR, giving all clinicians treating the patient an end-to-end view of their full medical history. The information is up to date and complete, enabling providers to make better clinical decisions and link the outcomes to value-based care.

"Having one system could lead us in the right direction toward stabilizing and standardizing the conversation around whole-person care," Gerard said. "So much of what we consider to be care management would go away with a single care platform, including scheduling, admissions, and the discharge and transfer reports."

A single platform also enables standardized treatment approaches. For example, if a patient comes to a hospital with heart failure, a clinician can quickly access guidelines for how to treat that patient's specific condition. They can also approve the corresponding orders with one click rather than manually and tediously entering information in multiple systems.

The connection between the social determinants that can impact patients' health – including access to safe housing, healthy foods, education, employment, and transportation – is now well understood. But even though more clinicians can refer patients to the right community resources for help, disparate systems make it difficult for them to know whether those interventions had an impact.

This information flows easily to providers when there's a single platform. Community organizations can quickly share when a patient receives support from a clinician because medical records are updated automatically. With such a comprehensive view of the patient's medical history and the resources they received, such as help paying a utility bill, clinicians are better equipped to provide whole-person care.

Technology also helps collect information. As a clinician and patient meet and talk in the care room, AI can transcribe their conversation in real time, converting it into a usable format and automatically uploading it to the EHR. Less time on admin means more time with patients and improved experiences all around.

Beyond the patient

While a single care platform can have a major impact on individual patients, it benefits whole communities too. With all this data gathered in a single place, providers can use analytics to better engage, educate, and support the unique needs of the populations they serve by predicting conditions for different zip codes, communities, or demographic groups.

For example, data show that Hispanic adults are 70% more likely to be diagnosed with diabetes than white adults. Or that many LGBTQ+ patients may be less likely to seek timely treatment for fear of discrimination, leading to a delay in care and poorer health outcomes.

By bringing together both individual and population risk factors and trends from the broader community, organizations can focus their efforts on early intervention where it's most needed. And by driving preventative care to stop health issues from arising in the first place, they can also improve community health.

Getting started

There are many lessons providers can build on to bring in a single system for case management.

"Be clear on why you're considering this technology," Gerard said. "And then translate that into measurable results."

She also underscores the importance of accountability, noting that "You need to be clear about roles and responsibilities. Decide who will do what before you move to how it gets done."

With those fundamentals in place, health organizations can take the following steps to improve case management:

  • Collect critical data. Predictive analytics and AI rely on relevant data, so gather all the information you can, including free-form notes
  • Stay focused on value-based care. It's easy to get caught up in reactionary care, but keeping patients healthy starts with acting preventatively
  • Communicate the change. Select an executive champion and develop a transparent, concise, consistent plan for communicating, training, and engaging with clinicians

Taking case management to the next level

The pain of toggling between multiple screens is just the tip of the iceberg. Working with a single case management system affects everything from the ability to identify health risks and give patients greater access to care to enabling faster turnaround times and looking after clinicians' wellbeing.

With the right technology, care management can become the function that finally equips clinicians to provide whole-person care. It starts with a single case management system that offers a full view of a patient's medical history no matter where or when they're getting help. And it ends with improved patient outcomes and care-team experiences.

About the Authors

This article first appeared in Pharmaceutical Commerce. It was authored by Erin Lloyd, healthcare transformation leader, Genpact, and Alex Kleinman, global healthcare leader, Genpact.

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