Integrating case management across the continuum requires that hospitals and post-acute providers think like an Accountable Care Organization even if they aren’t one.This kind of thinking requires that patients remain the center of the wheel around which all case management processes revolve.Every case management department must ensure that they are providing an infrastructure for managing patients across the continuum that includes hard-wired processes for identifying and managing the highest risk patients regardless of setting.
In this program you will learn how to coordinate the patient’s transition between healthcare systems and settings such as moving from the hospital to rehabilitation and home settings. We will discuss ways in which to maintain open communication between the patient, patient’s family or care giver and other members of the interdisciplinary healthcare team at all times regarding the transitional location.There will be a disucssion on how to apply strategies for involving the patient and family in decisions regarding care and transitional options.Since many factors impact on the integration of case management among and between providers these will be covered in detail including the role of the patient/family, physicians and other providers of care, case management and post-acute providers.Finally we will review best practice strategies for ensuring that patients do not fall between the many cracks and gaps in today’s healthcare systems.
While some hospitals are participating with the Centers for Medicare and Medicaid Services (CMS) as an accountable care organization (ACO),others are not yet participating.Even if your hospital or health system is currently not participating, many of the new CMS initiatives and payment changes still require that you think and behave like one.Bundled payments are one such example in which quality of care and costs must be managed across the continuum.Evidence shows us that case management can serve as the lynch pin that connects departments and disciplines across the continuum while retaining the patient as the center figure in the process.This program provides the attendee with concrete and implementable strategies for integrating and embedding case management across the continuum of care.
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department’s efficiency and effectiveness.
The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
Dr. Cesta has presented topics on case management at national and international conferences and workshops. Her books include “Nursing Case Management: From Essentials to Advanced Practice Applications”, “The Case Manager’s Survival Guide: Winning Strategies in the New Healthcare Environment”, “The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice”, “Survival Strategies for Nurses in Managed Care” and “Core Skills for Hospital Case Managers”.