Along the Continuum of Care: What Every Case Manager Must Know...

By Pauline Sanders RN

Along the Continuum of Care creates a mind shift for the case manager in the new paradigm to be effective agents of change and resource connectors. The urgent need to improve health outcomes is resulting in moment-to-moment changes in the world of case management. Along the Continuum of Care focus on helping health care professionals meet the new challenges with Health Care Reform.

Case Managers must educate the senior leadership team about the financial contributions that result from appropriate care coordination. The CEO is responsible for the bottom line but the buck stops with case management and leaders should focus on:
*Case management support for adequate resources.
*Ensuring that case management staff is educated, adequately staffed, and recognized for managing patient flow which maintains financial stability.
*Recognizing that effective case managers manage the tipping point to save and/or create millions of dollars for the organization.

The healthcare case management field is exploding. The demand will far outweigh the supply for the next three to five years and beyond. The business savvy case manager will lead the field.

• Language: English
• Publisher: AuthorHouse
• Release date: May 23, 2013
• ISBN: 9781481745475

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© 2013 by Pauline Sanders RN, MBA, CCM. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 05/14/2013

ISBN: 978-1-4817-4548-2 (sc)

ISBN: 978-1-4817-4547-5 (e)

Library of Congress Control Number: 2013907244

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Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Contents

Dedication

Acknowledgments

Introduction The Changing Paradigm Of Case Management

Chapter One The Continuum Of Care

Chapter Two The Case Manager’s Toolkit

Chapter Three What Case Managers Need To Know About Health Care Finances

Chapter Four Regulatory Agencies Impact Case Management

Chapter Five Documentation Challenges

Chapter Six Collaboration With Difficult People

Chapter Seven Care Coordination In The Pediatric Population

Chapter Eight Professional Development For The Case Manager

Chapter Nine Stress Management For The Case Manager

Chapter Ten Denial Of Services

Chapter Eleven Essential Leadership For Case Managers

Chapter Twelve Case Management Certification

Chapter Thirteen Interdependence Of Ceos, Providers, And Case Managers

Chapter Fourteen Health Care Reform… What Now?

About The Author

DEDICATION

This book is dedicated to my Mom and Dad who gave me a great start in life and to my two wonderful sons, Dale and Josh, who have expanded my experiences in life.

ACKNOWLEDGMENTS

I want to express the highest gratitude for the people who have helped me to meet the challenges to write this book. Special thanks goes out to Georgette Gigi Ligons, my business manager, from Braylen James Business Solutions who has cheered me on and supported me in sharing my passion about case management with the health care world. From the bottom of my heart, I want to thank my executive coach and mentor, Mark Susnow, Esq., of Inspire Possibility for moving me to this project, moving me through my commitments and being there to keep me on track when procrastination started. I could not have done this without you. Thank You.

INTRODUCTION

THE CHANGING PARADIGM

OF CASE MANAGEMENT

Either you’re an agent of change, or you’re destined to become a victim of change. You simply can’t survive over the long term if you insist on standing still.

- Norm Brodsky, entrepreneur

The urgent need to improve health outcomes is resulting in moment-to-moment changes in the world of case management. This means that agent of change and resource connector must now be added to the case manager’s multiple roles.

Ready or not, the future has arrived. Case managers find themselves being called to be more flexible and adaptable than ever before. They must approach their work with open minds and innovative ideas.

When moving patients along the continuum of care, many things go when they meet the patient’s needs in an acceptable manner, even if it goes against the grain of what was done in the past.

Case managers have only one goal and that is to ensure their care plans provides quality care for their patients at a reasonable cost to the health care systems.

This book is designed to help healthcare professionals understand effective case management and to meet the challenges of this exciting and essential profession. In the coming chapters there will be details on the tools and ideas case managers will need to better equip themselves to negotiate through this brave new world of health care. At the same time, there will be a continuing focus on the need for case managers to handle themselves and their patients with competency and integrity.

This book is based on the concept that to succeed in case management, it is essential for business logic to be applied to all decisions. As a result, the focus is not just on theory and standards of excellence in practice, but also on essential skills like critical thinking, streams of revenue for health care providers, the high costs of avoidable days of care, and the tools needed to negotiate one’s way along the continuum of