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Articles, case studies, and success stories to guide and inspire healthcare HR, Organizational Development, and Clinical professionals.


ACO Staffing Strategies: Redesign the Case Manager Role to Cut Readmissions Catalyst Learning
Operating a successful ACO requires a paradigm shift.  Since readmissions will directly affect Medicare reimbursements, hospitals must work to keep patients out, rather than in.  Most healthcare organizations know how to manage care within the facility, but what happens when the patient leaves the building? Since 2002, Catalyst Learning customer, University of Wisconsin Hospital and Clinics (UWHC) has dedicated significant resources to answer that question.  Challenged by capacity management and throughput issues, the UWHC recognized the need for a more aggressive approach to case management. Barbara Liegel, RN MS, serves as Director Coordinated Care and Home Care Programs at UWHC.  She explains that the traditional case management model blurred roles at UWHC. Staff within the hospital was not always clear on the agendas of the clinical case managers and social workers, and this lack of clarity caused overlaps in care. The subsequent redesign pushed the organization to eliminate duplication in roles.  UWHC established an offsite case management facility, the Resource Center, staffed with payer specialists, referral specialists, data analysts, and clerical support.  This team manages non-patient care aspects of the patient’s experience, things like discharge planning, communication with insurance companies and coordination with offsite treatment facilities such as physical therapy centers.  As a result, the clinical team is freed from non-care related tasks. “The Resource Center’s team helps the wheels continue to turn by picking up much of the ‘busy work’.  As we’ve evolved in the last decade, we’ve been able to enlarge it and cover outpatient requests.  It helped us become more efficient, even before there was such a thing as an ACO.” As part of the initiative, UWHC introduced a web-based system for creating and monitoring patient care plans helps streamline the process. “We have made this online system the primary vehicle for communication between providers, both inpatient and outpatient,” Liegel says.  “Embedded in the software are tools to assess the fit between patients’ needs and hospital services and to monitor trends in admissions and discharges.” UWHC still operates with the same number of staff, but with very clear and well-defined roles. The new model has eliminated the overlap in care and holds everyone accountable for his or her actions. Licensed clinical staff now has more time at the bedside.  They are available to push their clinical colleagues, to look at medical necessity criteria and question if the patients even need to be in the hospital or transitioned to outpatient. Liegel credits her forward-thinking colleagues with driving the change forward. “The support from senior management and having a staff that was willing to analyze and improve their processes was instrumental. A change this big is not something that happens overnight. We are still trying to perfect our processes and will continue to do so.”




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