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Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators
Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators
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A forerunner in embedded case management, Aetna began placing nurse care coordinators in primary care practices in 2007, buoyed by returns from its telephonic case management efforts. Since then, the payor has clearly demonstrated the value of embedded case managers working side-by-side with physicians serving its Medicare members.

Likewise, several years ago, Bon Secours Health System started embedding case managers within practices, putting them to work as nurse navigators for patients with complex needs or for those experiencing transitions of care.

Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators documents the experiences of Aetna and Bon Secours in the recruitment, education, workload management and IT support of practice-based case managers.

In this 40-page resource, Dr. Randall Krakauer, Aetna's Medicare medical director, and Irene Zolotorofe, administrative director of clinical operations at Bon Secours Health System, provide a primer on the construction of a co-located case management initiative, answering 35 FAQs on embedded case management and sharing lessons learned on the following program concepts:

  • Recruitment sources and strategies;
  • Preferred background and skill sets of case managers;
  • Fitting the case manager into the practice, preparing the practice for placement and building a trusting relationship between the case manager and the physician;
  • The case manager's role on the physician-led care team;
  • Training strategies for embedded case managers;
  • Tools used by case managers, including how to utilize the expertise of each case manager across the continuum;
  • Typical caseloads of embedded case managers, caseload management strategies and standards of care;
  • Benchmarks to evaluate the case managers' effectiveness;
  • Healthcare utilization results from Aetna's telephonic case management program, its collaborative case management model and embedded care management;
  • How health risk assessments, predictive modeling, prior healthcare utilization and physician referral identify members for case management intervention;
  • The reimbursement and incentive formula for Aetna's embedded case managers; and
  • Impact of Aetna's embedded case management on member satisfaction and retention rates.

Table of Contents

  • Recruiting, Training and Caseload Management for Bon Secours Nurse Navigators
    • Attributes of a Nurse Navigator
    • Orientation and Training of Nurse Navigators
    • Resources and Tools
    • Supporting the Hospital Discharge
    • Disease Management and Risk Stratification
    • Medication Management
    • Caseloads for Embedded Case Managers
    • Results from Nurse Navigator Efforts
  • Value of the Embedded Case Manager for Aetna's Medicare Population
    • Differentiating the Medicare Population
    • Physician Partner Collaboration Model
    • Payments for Quality Metrics
    • Transitioning to Accountable Care
  • Q&A: Ask the Experts
    • Staffing Ratios in a Multi-Site Physician Network
    • Functions of the Virtual Case Manager
    • Additional Sites for Embedded Case Managers
    • Clinical Ladder Program
    • Group Visits
    • Selecting Practices for Embedded Case Management
    • Case Management Hot-Spotters
    • Identifying Transitions of Care Patients
    • When to Increase Caseloads
    • Telemonitoring for Heart Failure Patients
    • Getting Physicians to Embrace Embedded Case Management
    • Business Case for Hosting a Case Manager
    • Financial and Quality Benefits of Practice-Based Case Management
    • Preparing the Practice for a Case Manager
    • Criteria for Practice Selection
    • Funding the Embedded Case Manager
    • Background of Embedded Case Managers
    • Transitioning from Telephonic to Embedded Case Management
    • Embedded Case Managers' Role
    • Identifying Practices for Participation
    • Aetna IT Requirements for Embedded Case Management
    • Patient Contact
    • Case Managers in the ER
    • Incentives for HRA Completion
    • Measuring Satisfaction
    • Characteristics of Top-Performing Practices
    • Home Visits
    • Case Management for Advanced Illness
    • Evaluating Compassionate Care
    • Embedded Case Management for Non-Medicare Business
    • Ensuring Case Management Follow-Up
    • Providing Patient Data
    • Identifying Patients for Compassionate Care
  • Glossary
  • For More Information
  • About the Presenters
Video
Publication Date: August 2012
Number of Pages: 40
ISBN 10: 1-937229-87-4 (Print version); 1-937229-88-2 (PDF version)
ISBN 13: 978-1-937229-87-0 (Print version); 978-1-937229-88-7 (PDF version)
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