Case management is a critical component of healthcare that has not always been fully recognized for its potential to enhance patient and provider satisfaction, quality of care, and cost containment. However, in today's healthcare landscape, with Value-Based Purchasing holding providers, health systems, and other professionals accountable for the quality and efficiency of their work, case managers have a unique opportunity to demonstrate the value they bring to patients, healthcare teams, and payers. In this upcoming webinar, Anne Llewellyn will discuss practical strategies for case managers to leverage data and outcomes to illustrate the significant impact they can make in the complex and ever-changing healthcare system. By showcasing the results of their work, case managers can prove their worth and demonstrate how they can contribute to achieving the goals of Value-Based Purchasing, including improved patient outcomes, higher satisfaction rates, and reduced costs. Don't miss this opportunity to learn how case management can help drive success in a value-based healthcare system! Register Now, https://conferencepanel.com/conference/demonstrating-the-role-of-case-management-in-a-value-based-healthcare-system

1. Demonstrating
the Role of Case
Management in
a Value Based
Healthcare
System
Anne Llewellyn, MS, BHSA, RN, CCM-R, CRRN, CMGT-
BC, BCPA, FCM
Professional Case Manager

2. Learning Objectives
Define case
management
and its role in
today’s
healthcare
system.
01
Share
healthcare
metrics that can
validate the
value of case
managers and
their role in the
healthcare
system.
02
Discuss the
various areas of
case management
and how they
work together to
lower costs and
assist patients,
families, and
healthcare
professionals.
03

3. Outline
Role/function of case management
How case management is changing
The value they bring to the people who use the
healthcare system
The value they bring to the healthcare system
Importance of case managers demonstrating their
value
Demonstrating value through quality, patient-centered
care, and cost containment.
Importance of professional development for all
members of the healthcare team

4. Role and
Function of
Case
Management
• Case managers are healthcare professionals who
serve as patient advocates to support, guide and
coordinate care for patients, families and caregivers
as they navigate their health and wellness journeys.
• The underlying premise of case management is
based in the fact that when an individual reaches
the optimum level of wellness and functional
capability, everyone benefits: the individuals being
served, their support systems, the health care
delivery systems and the various reimbursement
sources.

5. Core Function of Case Management
• Identify patients who need assistance
• Set short- and long-term goals
• Engage the patient family in the plan of
care
• Develop plan of care to meet the
individual needs of the patient
• Improve communication between with all
stakeholders
• Educate the patient regarding their
diagnosis/condition
• Research resources to meet the needs
of the patient/family
• Work with the payer to maximize
insurance resources in a cost-effective
manner
• Proactively monitor the plan of care to
ensure it meets the needs of the
patient/family (adjust as needed)
• Evaluate the plan care periodically
• Report outcomes:
• Did you meet the patients' goals?
• Did the patient/family engage in the
plan of care?
• Did the patient/family gain
knowledge regarding the plan of
care
• Was there a safe transition of care
• Was there a follow-up call to see if
needed resources were received?

6. How Case Management is Changing
Demonstrate Outcomes
• Self-Outcomes
• Patients
• Organization
Communication mediums
• Face to Face
• Virtual
• Electronics
Documentation
• Electronic Health Records
• Patient Portals
Empower Patients/Families to be Active
Members of the Healthcare Team
• Research their own care
• Ask questions of their team
• Involve the patient in the developing
the plan of care
• Make Sure the Plan of Care is
meeting their individual needs
• Palliative Care and End of Life
Education
• Professional Continuing Education
• Advanced Education/Certification
• Career Path

7. Case Management
Setting
• Hospitals
• Managed Care Organization
• Rehabilitation Centers
• Acute
• Long Term Acute Care Hospitals
• Skilled Care Facilities
• Inpatient and outpatient programs
• Physician Practices
• Clinics
• Prison Healthcare
• Other

8. Why Case Managers NEED to
Demonstrating Their Value
• Other members of the
healthcare team must show
value. Why not case
management?
• Elimination due to cost cutting
efforts
• Replaced by a lower level of
staff
• Advances in Technology
• Humanizing Heath and
Healthcare

9. KPI Case Managers Can Use to Demonstrate Their Value
• Improved Communication
• Improved Care Coordination
• Improved Quality
• Safe Discharges
• Patient Education/Empowerment
• Alternative Plans of Care to Meet the
Patients Needs
• Improved Patient and Provider
Satisfaction
• Cost Containment

10. Metrics Case
Managers can use with
the Patient/Care Giver
Assist patients and families in
meeting their needs
Serves as a liaison between the
payor and healthcare team
Through their work, case managers
‘work themselves out of a job’ by
empowering the patient/family
Educate and be a role model to the
patient/family to improve care
coordination transition of care
Assist patients/families in managing their care
•Prepare for doctors/therapy appointments
•Keep notes/records (manually or electronically)
•Be an active member of the healthcare team

11. Systems to
Analysis
Metrics
• With proactive alerts and real-time patient data,
care transitions and communication are optimized
for better outcomes, increased profitability,
improved patient experience, and reduced
readmissions.
• Systems to harness the power of healthcare data,
your organization can deliver actionable insights
that improve patient outcomes at scale and
enhance an organizations bottom line.

12. Mediums to
Demonstrate Value
• Internal Meetings with C-Suite
• Department Meetings
• Local meetings with Employers, Consumers
• National Conferences
• Patient and Family Councils
• Professional and Non-Professional
Publications
• Organization Website
• Social Media
• Other

13. Professional Development for
Case Managers
• Healthcare is evolving rapidly
• Care/treatments
• Communications
• Artificial Intelligence
• Machine Learning
• Diversity, Equity and Inclusion
(DEI)
• Genetics/Biotechnology
• Other

14. Resources
Case Management Standard of Practice: https://cmsa.org/sop22
A Practical Guide to Acute Care Case Management: The Day to Day “How To Be An Acute Care Case
Manager” Resource, Dr. Colleen Morely
The Ethical Case Manager: Tools and Tactics, by Dr. Ellen Fink-Sammnick
2022 Case Management Salary and Trend Survey https://website-
cmi.s3.amazonaws.com/2022+Case+Management+Salary+and+Trends+Survey+copy-compressed.pdf
Humanizing Healthcare: Hardwire Humanity into the Future of Health, Dr. Summer Knight

15. Professional
Organizations and
Accreditation
Bodies
• American Association of Managed Care
Nurses (AAMCN)
• American Case Management Association
(ACMA)
• America's Health Insurance Plans (AHIP)
• Case Management Society of America
(CMSA)
• Commission for Case Manager
Certification (CCM)
• National Council for Quality Assurance
(NCQA)
• Population Health Alliance
• URAC

16. Thank You
• Contact information
• Anne Llewellyn
• C: 954-254-2950
• Email: allewellyn48@gmail.com
• Website: https://nursesadvocates.com
Register Now