Increasing Case Management Effectiveness

Increasing Case Management Effectiveness
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Executive Director, AllCEUs Counseling Continuing Education
Host: Counselor Toolbox and Case Management Toolbox Podcasts
Objectives
– Identify the benefits of case management
– Explore the impact of ineffective “standard” treatment
– Identify goals of the case manager
– Review the research identifying the most helpful factors in case management
– Review assessment areas
– Explore common needs of CM clients
– Describe characteristics of effective care plans
Intro
– CM can be defined as a “coordinated integrated approach to service delivery, ongoing supportive care and help to access resources for living and functioning in the community”
Why Case Management
– Frequent users of healthcare services are a small group of patients with multiple chronic conditions and psychosocial and mental health comorbidities accounting for a high number of healthcare visits
– Frequent use of services is often considered a symptom of gaps in accessibility and coordination of care.
– These patients are more at risk for incapacity, poorer quality of life and mortality.
– Case management (CM) is the most frequently implemented intervention to improve care for frequent users of healthcare services and to reduce healthcare usage and cost
– CM interventions resulted in decreases in ED use and cost, a better use of appropriate existing resources, and a reduction in social problems such as homelessness and drug and alcohol abuse
Impact of Ineffective Treatment
– Treatment dropout
– Continued illness
– Work impairment
– Financial problems
– Relationship impairment
– Impaired parenting
– Stress related health problems
– Development of (additional) mood issues

Case Example
– John has a substance use disorder, major depressive disorder and hepatitis C. He doesn’t know how to afford his medication for hepatitis or his depression, has a history of suicidal ideation and has a history of relapse. Currently he is living in a local motel. He recently lost his job and got a DUI.

– Counselors review your provider administration manual. Most insurers offer care/case management programs.
– http://www.aetna.com/healthcare-professionals/documents-forms/bh-provider-manual.pdf

Goals
– Increase/maintain client engagement/motivation by:
– Improving health literacy
– Identifying and addressing obstacles (payors, transportation, language/literacy, childcare)
– Identifying and enhancing strengths
– Serving as a healthcare guide
– Providing support and encouragement
– Reducing symptoms
– Reducing the burden on caregivers thereby improving the psychosocial environment (emotional support, social support, domestic help, insurance, transitional services)
– Increasing confidence in caregivers and clients for self-management
Helpful Factors in Case Management
– Helpful Factors
– Access to medical, social and community resources
– Calm and trusted case manager
– Case manager with strong relationships to referral sources
– Effective communication between CM and treating clinician(s) via a unified treatment strategy
– Multidisciplinary care plan
– Life skills coaching
– Frequent contacts with care provider
– Regular review of the care plan with the client
– Assistance with healthcare navigation
– Patient education/Health literacy enhancement
– Coordination and prioritization of care

Assessment Areas: Client and Caregiver
– Emotional needs
– Cognitive functioning
– Physical complaints
– Sleep
– Current physicians, medications, diagnoses and treatment plans
– Motivation
– Knowledge about the condition
– Health literacy
– Access to safe housing
– Access to healthy meals
– Ability to perform ADLs (cooking, bathing, dressing medication, paying bills, domestic chores…)
– Social supports
– Meaningful activities
– Transportation
– Financial stability
– Vocational issues (CRC, Job coach, ADA-advocacy)

Needs
– Early diagnosis and intervention
– Education regarding the condition(s)’, exacerbating and mitigating factors and the course
– Active involvement in care planning
– Clear explanations of treatments and expectations
– Meaningful guidance on addressing emotional and behavioral issues
– Legal assistance (referrals) regarding guardianship, power of attorney, advanced directives
– Financial planning and resources if caregiver has to quit a job, house remodels, long term care expenses, medication…
– Advanced care planning for future problems

Needs
– Social and emotional support
– Access to specialists (geriatric physicians, pain management, addicitionologist psychiatrists, palliative care specialists)
– Meaningful activities
– Assistance with ADLs
– Management of behavioral, mood and cognitive issues
– Safety management

Effective Care Plans
– Relate directly to the assessment
– Improve mood as evidenced by an average self-report of happiness of a 3/5 each week, bathing daily, completing daily chore list and connecting with at least 1 friend each day
– Sally will attend outpatient therapy with Dr. Smith once per week
– Case Manager will link Sally with transportation services to ensure ability to attend therapy appointments
– Dr. Smith will seek preapprovals at least 3 days before the final approved session
– Sally will set a reminder on her phone to complete between-session assignments from Dr. Smith
– Sally will take her sertraline as prescribed each day
– Sally will put a reminder in her phone to make an appointment with Dr. Jones at least 2 weeks prior to needing a refill
– Sally will set a reminder on her phone to connect with one friend each day
– Jane, Sally’s partner, will assist Sally in identifying depression triggers and engaging in distress tolerance activities
– Sally will keep a daily log of her mood, if she takes a bath, what she eats, her chore list and if she connected with a friend.
Documentation
– Assessment summary and notes
– Capture relevant data elements
– Present accurate customer “snap shot”
– Deficiencies and barriers should link directly to services and activities
– Sequential tracking and reporting of client contact and progress
– Describe newly emerging barriers
– Revise action plan
Documentation
– Why are notes important
– If it isn’t written, it didn’t happen
– Helps clients and providers conceptualize progress, identify and ameliorate barriers
– “In-house” sharing of important data and action plans critical to customer service
– “External” sharing is critical to optimizing referral relationships
Summary
– Access to, and close partnerships with, healthcare providers and community services resources are key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team
– Assessments and interventions must be biopsychosocial and identify who, what, when, when and why