Case Management Solutions
At peak performance, case management professionals are care-agents for healthcare organizations in assuring appropriate care management, care coordination and transitional care service are in place. Case management acts communicates and collaborates uniquely with the entire healthcare team and associated parties to validate medical necessity, monitor length of stay, prevent denials and reduce unnecessary hospital re-admissions.
In concert, case management acts as an advocate for patients, monitoring timely delivery of healthcare and throughput from the hospital to the post-acute setting. DSE Associates offers strategies to help healthcare organizations succeed clinically, socially, financial and regulatory.
Sometimes solving one problem creates another, with ripples throughout the system. When the ripples become waves, it is time to take a close look at the whole system.
- Is case management functioning efficiently and effectively?
- Are interdepartmental relationships helping accomplish goals and meet regulatory requirements?
- Does the hospital’s financial reports and case management dashboard indicate positive outcomes?
The answers to these questions may indicate a need to take an in-depth look at case management, from evaluation to model design. DSE Associates provide comprehensive systematic assessments, resulting in recommendations (and implementation) of plans which identify the areas of concentration to assure best outcomes and performance in the following areas:
- Reporting structure
- Leadership development
- Clinical criteria selection and use
- Department structure — centralized or decentralized, unit specific, service based, combined model
- Staffing and roles by discipline
- Staff orientation/mentoring/evaluation
- Hours of operation
- Department functions/workflow process
- Utilization management committee development and the physician advisor role
- Interdepartmental relationships
- Regulatory compliance
- Denials management
- Recovery audit preparedness
- Outcome measurement and management
- Orientation of key stakeholders
- Tool development and systems
- Interim management solutions
- Case Management information systems recommendations
- Patient center medical home model development
DSE’s consultants work beside our clients from administration, finance, case management and the healthcare team to all external providers to assure the implementation goes smoothly, with results achieved that are the best practice solutions.
Transitional Care Management and Throughput
Transitional Care Management considers a patient’s medical, physical, cognitive, economic and emotional capabilities as well as their available support system in preparation for discharge from the hospital. In an effort to manage care effective, healthcare organizations must seamlessly manage their clinical course of care and transition from the hospital to the community. Payer requirements and CMS beneficiary rules, along with incentive programs allow for healthcare organizations to improve processes for proper care management.
To improve clinical and operational effectiveness, DSE Associates assist providers in reducing clinical variation and optimizing length of stay; while enhancing patient flow and maximizing clinical capacity from the outpatient setting, to the emergency room, the inpatient setting, the community. DSE evaluates clinical care coordination and collaboration, quality, desired outcomes, structure and medical management processes that will lead to solutions that improve patient flow, minimize unnecessary re-admissions/ER visits and allow organizations to consider new opportunities.
- Clinical and operational effectiveness
- Post-discharge care management services
- Resource management
- Outpatient care management – patient centered medical home models
- Population health management methodologies
DSE Associates offer hospitals and healthcare providers the capabilities to successfully address many challenges which impacts the performance of leaders and their employees to serve larger organizational needs. Sensitivity is key to empowering, transforming supporting new and existing leaders and employees in case management in reaching their professional goals beyond what is expected. DSE has comprehensive knowledge of best practices, combined with real-world clinical and professional expertise to determine opportunities to establish long-term results and innovate. We work closely with our clients to uniquely develop a variety of powerful, proprietary management tools and alternative solutions that become an essential part of hospital and case management operations.
- Strategic planning
- Leadership coaching and mentoring (cm director, manager, physician advisor)
- Change management and team building
- Staffing solutions
- Education and training
- Proper alignment of the case management with the healthcare team to address status management, pre-post admission – all procedures, care coordination and throughput.
- Application of clinical criteria to assure medical necessity and decrease denials and enhance quality of care for their patient population.
- Reduced monthly write-offs and lost revenue
- Increased efficiencies and optimal length of stay
- Improved medical/healthcare staff communication and collaboration
- Developing a clinical documentation program to assure proper placements of patients
- Educating physicians and the entire healthcare team on medical necessity documentation for outpatient/observation placements and inpatient admissions
- Assuring regulatory compliance of the entire healthcare team to include specific Centers for Medicare and Medical Service regulations.
We change outcomes by building strong relationships!
DSE Associates has provided service to leading hospitals and healthcare systems across the United States. Our clients have valued our expertise and the ability to transform their utilization, case management and transition/care coordination programs.