In hospitals across the country, cardiovascular (CV) patients comprise the majority of admissions, and this number will undoubtedly continue to grow due to the aging of the population and greater incidence of CV disease. With higher acuity and co-morbidities like diabetes, these patients are under scrutiny by CMS and other insurers. Furthermore, these patients are more likely than others to suffer from complications due to the stress generated by a hospital admission, which increases the susceptibility for blood glucose abnormalities (often hyperglycemia), and also because of multiple invasive tests and major surgical procedures like open heart surgery. Without tight glycemic control, related complications will often lead to longer lengths of stay (LOS), higher care costs, and increased resource utilization.
For these cardiac and vascular patients, Corazon believes that a service-line, disease-based, case management approach is most effective for decreasing LOS, reducing costs, and managing resources while improving quality outcomes. In fact, focused efforts related to care standardization, such as clinical pathways, disease-specific guidelines, and targeted clinical surveillance for complications, can have a positive effect on these measures and result in better patient care overall. Utilizing a case manager who brings expert clinical, documentation, and reimbursement knowledge in a niched specialty such as cardiovascular, can align the goals of all practitioners and create a team focused on high quality care at the lowest cost. Based on the Healthways case management model, patients requiring an additional focus on glycemic control, for instance, would also be followed across the full inpatient continuum in coordination with the cardiovascular clinical care team. In order to impact the quality, timing, and cost-effectiveness of healthcare services within cardiovascular services, both Corazon and Healthways support the use of clinical case managers as an integral part of a multi-disciplinary team that proactively guides patient management. A successful case management approach stratifies low-risk patients and standardizes their care through multi-disciplinary clinical pathways, guidelines, order sets, and/or protocols in order to meet pre-defined quality and cost goals. Since case managers are integrally involved in understanding the care needs of patients, they can be collecting daily data related to cost/LOS/quality improvement opportunities as well as patient outcomes (clinical and cost) at the point of care. Corazon and Healthways believe that the case manager is a front line staff member privy to a detailed understanding of process improvement opportunities and is essential to the care delivery process. In order to effectively redesign processes as indicated by the aggregated outcomes, the case manager should be part of the multi-disciplinary team in order to make significant and sustainable changes. In order to allow time for case manager input into the analysis and improvement of patient outcomes, streamlining daily workflow is essential. Daily focus should include patients scheduled for procedures, those admitted overnight, as well as those readmitted (often heart failure patients who require an additional focus or who could be cared for outside the hospital). To identify glycemic patients, additional data might also be required from lab, pharmacy, dietary, and even clinical documentation systems. Clearly, a successful case management program must not only identify key patient populations for individualized case management, but also oversee and involve bedside staff in using case management tools to facilitate proactive care management for all patients. We believe that effective case managers are integrated within the multidisciplinary care team, utilize information technology to generate efficiencies, and are integral in aggregating and analyzing data in order to drive quality improvement and cost reduction efforts. Indeed, both Corazon and Healthways recommend a solid case management structure that seeks to improve patient outcomes, while reducing hospital costs and maximizing reimbursement.
