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welcome to case management toolbox podcast sponsored in part by all CEUs continuing education I'm your host dr. Donnelly Snipes case management CEUs are available for these podcasts at all CEUs dot-com / case management that's all CEUs com / case management I'd like to welcome everybody today's presentation on standards of practice for case management and I know in some waves in a lot of ways that sounds terribly dull however I think you're gonna find
0:46
that this might be relatively enlightening it is based in part on the standards of practice for case management by the case management Association of case management Society of America today we're going to explore the benefits of adding case management to your skill set a lot of you are clinicians therefore you are probably you know doing case management some but it's really one of those other duties as as assigned however case management actually
1:19
can be a business all in its own and it can be quite lucrative we'll also explain the principles of case management identify practice settings that you might be able to get some contracts or find jobs and review risk factors or targets for case management
1:37
why case management well it can be an adjunct to clinical practice there are only so many hours in a day that most of us are comfortable doing individual or even group counseling at a certain point we start getting kind of bleary-eyed and part of that depends if you're working for an organization how many billables you have however a lot of us especially those of us who are in private practice who have the flexibility to do a variety of different things would
2:13
probably rather not see more than three to five clients in a particular day just because it can be so mentally taxing and emotionally taxing to see more than that what do you do with the other three hours how can you turn those into billable hours case management is one option case management does require you to think and do work but it's different and a different type of mental gymnastics that you're doing case management enhances coaching and clinical services
2:46
it helps people take what we talked about in coaching or clinical sessions and translate it into practice case managers often hope the person look at their treatment plan and figure out okay what's the next step to implement it they are the scaffolders if you want to think of it that way they're the people who are going to help clients identify and work around obstacles on a relatively regular basis we see them once a week a case manager may be touching base two three
3:23
four times a week case management can be its own business in this high cope a high deductible world there's a lot of people who don't want to have to pay to be hospitalized case management can be really helpful case managers can help people stay out of long-term care facilities or transfer from long term care to home in or short term care to home in a shorter period of time they may not be
3:54
able to just you know go home they may need some assistance but the case manager is the one that will help bridge the gap of that transition with high copay and high deductible kind of going over a couple of insurance terms here for those of you who are relatively unfamiliar your deductible is what you have to pay before insurance will pay a dime and a lot of people are going with high deductible plans because insurance is so expensive so they have to pay three five ten thousand
4:25
dollars before insurance even kicks in high copay means that even if they have a low deductible and insurance is paying something they may still be paying twenty to forty percent twenty percent of a hospital stay can be really expensive 20 when my son was in the NICU just a privilege of having the bed in the NICU not including the doctors and the treatments and everything else but just the privilege of having the bed was ten thousand dollars a day so 20 percent of ten thousand
5:00
is a lot of money when you consider he stayed there for six weeks and people are regularly confronted with this when they have elderly family members when they have family members who have surgery when they have family members who are unable to live independently completely independently intensive case management can be implemented and can be much more cost effective another issue with case management or to help you understand how case management can be profitable
5:38
is called capitation and that's another one of those insurance terms capitation basically means if you are at agency ABC and you get the contract with Medicare or Medicaid to be the HMO provider for behavioral health services well that's great you know so this organization ABC got this contract capitation means their Medicare or Medicaid the insurance company is gonna say okay in your service area we have a hundred thousand people that are enrolled in our program twenty
6:16
percent of those people are expected to need ten sessions of brief therapy and we compensate at $45 a session therefore it's expected that in this population to provide the care they need will cost about nine hundred thousand dollars a year that's you know twenty thousand twenty percent of the hundred thousand times forty-five dollars times ten brief therapy sessions is nine hundred thousand dollars a year and you may see seeing that number going cool that's a lot of
6:52
money but what happens if thirty percent of those hundred thousand people start needing care well you don't get any more money you have to make do with the nine hundred thousand dollars you got to serve those people what happens if only 10% of those people need services well then you have a surplus and that's a good thing to an extent a lot of times with capitation it's sort of a use-it-or-lose-it philosophy if only 10% of the people needed services and you only
7:30
used you know five hundred thousand of the month the money that year then the insurance company may start to rethink what their population utilization rates are going to be so the next year you may get a lower amount it's a balancing act that your CEOs and your CE OS will worry about the take-home message if you're working with an agency that is in a capitated contract with a an HMO it behooves them strongly to make sure that the population that is enrolled with that
8:08
insurance company stays healthy the less they seek services the more profitable the years going to be that's where management comes in case managers can really help at identifying areas for early intervention you know if somebody stops taking medication or they're starting to decompensate case managers can identify that earlier then people generally independently will reach out for help case management gets people in the door sooner yes it does get people in the door but it
8:47
gets them in the door sooner so they can address the problem before it becomes a huge issue kind of like when you get a cut on your arm you know if you treat it right after you get it the likelihood of it getting infected and you having to go to the doctor is pretty small but if you you know get that cut and you don't do anything you don't pay attention to it or you wait a week then there's a chance that you're going to have a much more expensive doctor bill
9:20
case managers ensure wraparound services most of us as clinicians mental health clinicians especially social workers are a little bit more involved with with case management but with mental health clinicians at least according to NBC see case management is not part of our job description well in reality if you've ever worked in community mental health it is because the places that will pay for case management the insurance qualifications for case management
9:58
services are pretty intense somebody has to have a severe and persistent mental illness and meet all these other criteria in order to qualify for case management services in most states you know I'm not saying everywhere but most states that's true a case manager can help though if your agency is willing to pay for it or if your university or clinic or whatever will get to work places pretty soon the case manager can ensure that the people are getting all of those wraparound
10:39
services we've talked in other courses about how if people are not getting those basic needs met on Maslow's hierarchy they're not getting their nutritional needs met they're not getting adequate sleep they're not living in a safe environment not addressing comorbid medical issues they are going to likely have mental health problems as well it's going to contribute to depression anxiety grief frustration so better health leads to better mental health case managers are great at
11:12
helping people tap into those wraparound services to improve their physical health case managers are great at helping people improve their health literacy their ability to take in information and make informed choices that's great and better health literacy is linked to better mental health case managers are useful for helping people reduce stress that's not a diagnosed about the SM thing
11:43
unless you want to call it adjustment disorder but we're just gonna call it stress case managers can be very helpful at identifying some of those ancillary things not the cognitive or affective things but financial issues if somebody stressed out because they're having financial problems case managers can help people link with financial counsellors and services and resources in the community they can help people with interpersonal stress maybe they're having challenges with their
12:16
child or they're having challenges with their relationship case managers can help people link to counselors or support groups occupationally somebody may be really unhappy because they are in a job that they really hate or they're burnt out or whatever the case may be case managers can help people connect with career counselors and resources that can help them find options you know not saying that they're necessarily going to take those options but can help them explore
12:58
options reducing stress reduces improves mental health McCann plan compliance leads to better mental health we're assuming that we're writing great treatment plans and if we can keep people moving forward on that plan toward their goals then they're going to theoretically have a greater sense of self esteem self efficacy and contentment case managers ensure non fragmentation of services it's so easy with all the different doctors out there for services to get fragmented and people
13:36
providers on a multidisciplinary case to not be part of a team they're just you've got an inner chronologist over here and a pain-management over here and a PCP over here and a counselor over here and the person's going to all of them but none of them are talking which means they can either overlap in their services they can contraindicate each other or lots of different things can happen case managers serve is that single point of contact and ensure that everybody is on the
14:11
same page in terms of the service plan and knows so the right-hand knows what the left hand is doing the little bit of administrative work but it goes such a long way to enhancing the clients experience so they don't feel like well my endocrinologist has no idea what my pain management physician is doing and they seem to be giving me mixed messages if everybody's on the same page there won't be mixed messages case managers are great for providing guidance
14:47
during service transitions which leads to better treatment compliance and better mental health if somebody is released from the crisis stabilization unit or discharges from residential treatment and into outpatient you know that's a big transition you know they went from being hospitalized to 24-hour unsupervised situation and that can be really scary for the family and for the client
15:21
case managers can help people create a safety net so the transition is smoother and they don't feel like they are a fish out of water just kind of flapping on the ground case managers also provide advocacy within the community talking to leaders and identifying funding service gaps they can go to the County Commission they can go to different places that may have funding and even foundations writing grants for foundations to get money to create programs to fill gaps and services
16:02
can be really helpful I know the organization I used to work for that's one of the things I used to do was write grants and I loved it quite honestly but that was when I saw that there was a need I would go and I would find grants that were available and we would apply for them and then when we got what whichever grants that we got I would be involved with implementation of that grant sometimes it was creating a community coalition and another agency would take the lead
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but I was also able to you know pass that grant on and go hey there's this grant out here that can help you do that case managers do really well and is very effective especially if you're in private practice as a case manager you're a contract case manager to be involved in community coalition's so people know that you're out there and you are communicating with all of the stakeholders not just clients not just doctors but all of the stakeholders in the community and
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generally case managers are less expensive than clinically licensed providers most states are not going to say all because I don't know all but most states don't require case managers to be licensed in order to practice a lot of organizations if you want to be hired in as a case manager at the highest reimbursement tier then or I a salary tier then you're going to want to be a certified case
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manager but a lot of people are able to be case managers without necessarily being a certified case manager especially if you're already licensed if you are licensed as a clinician then you know you've got that professional practice umbrella that you're working under
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case management can be applied to individuals or groups of clients such as in disease management or population health services you may be thinking to yourself alright case management sounds like it might be kind of interesting because I love helping people connect with resources and figure out how to make the system work for them well great what can we where can we work you can work at universities targeting underage drinking or STD prevention or violent dating violence
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awareness any of those things there's often a health educator or a case manager that is employed by universities to do those educational campaigns you can work for clinical practices or foundations like the Diabetes Association or like American Heart Association to educate people about in general this is going to be one of those Universal interventions educate people about the condition whether it's diabetes or heart disease or premature birth in order to prevent it
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from happening but also if it does happen you may be involved in helping people access services if somebody has a preterm infant most obstetricians and pediatricians know about the resources that are out there now but not in all situations therefore somebody may call the March of Dimes and want information about what types of resources are available to families who have a micro preemie well bada-bing you're able to make that connection for people you can work in cancer diabetes
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depression or autism management situations where you're working in clinics or foundations again that either educate about the issue or help people manage it if you're working with a pediatrician or a psychologist that specializes in working with youth with autism they may have a case manager that sees the client in between clinical visits in order to again ensure the implementation of the
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treatment plan help families when they hit hurdles or obstacles or don't understand something takes a lot of pressure off the primary clinician you can also work at the Area Agency on Aging geriatric physician groups long term care facility short term care facilities you know the list goes on you can provide services to people who are aging my grandmother and I've talked about her before
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when she finally got to the point where she could not be independent live independently anymore she couldn't live by herself and she didn't want to move in with my uncle or my mother so she ended up having to go to a long-term care facility and there was a case manager that helped ease that transition and helped her figure out what to do with her belongings and how to put the house on the market and all that kind of stuff helped my family make that transition as she moved to that
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higher level of care the goal of case management is achieving client wellness and autonomy through advocacy commune patient education identification of service resources and service facilitation case managers often don't provide a lot of the services they link no sense reinventing the wheel they link clients and their families with the services that are currently in existence it increases
22:19
utilization of those services which is great for those practitioners who you know have other built more billable hours but it also reduces you know maybe the number of times the person's gonna have to see that person so instead of having to see a mental health counselor for six months the case manager may be able to help the client implement the treatment plan and do well on 16 weeks who
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knows services are best offered in a climate that allows the direct communication between the case manager the client and appropriate service personnel how frustrating is it when you are a client and most of us have been clients either doctors or dentists or somewhere else where you felt like you were just being told what to do and you didn't have any say in it it's exasperated the case manager is there not only to facilitate communication between the providers on the
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team but the client is part of the team in case management we're really talking about you know you're the expert on you let's talk about what's your input on this when an individual reaches the optimum level of functioning for them everybody benefits the clients feel better they're healthier they're gonna have fewer medical visits fewer mental health visits their fewer days off from
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work there's they're gonna if they're having fewer days off from work then they're probably gonna be making more money which means they're gonna be spending more money which supports the economy you can just ripple effect this we want people to be happy and healthy the support systems benefit because they're not worried about the client anymore they're not experiencing financial or time drains for habit from having to take care of the client if that was happening they
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are able to focus on their jobs their families their recreation their mental health it benefits health care delivery systems like I said we're gonna potentially reduce the number of people that need services which means we're going to free up slots for the people who really really need services and we are potentially going to be able to help reduce the duration of services by ensuring that the care is goes through smoothly and in community mental health I know you know
25:04
again part of one of the clinics I supervised was an outpatient clinic and a lot of the clinicians didn't like discharging the clients who showed up every single week that was a guaranteed billable hour gosh darn it and they got part of their evaluation was based on billable hours now we can talk about what's right and wrong about all that at a different point the point being they didn't want to discharge those people so then when there were new clients who had emergent
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needs there wasn't a slot open for them case management can really help ensure that people are not staying people are benefiting from brief therapy let's just say that and that when one seat empties that something else flows in there so you're not having you know people worried about it yes in an ideal system if it's functioning great and case management is working like it should you may not need as many clinicians they may have to transfer to other job titles that's
26:21
possible but highly unlikely we know how mentally emotionally distressed a lot of people in America are right now I find it hard to believe that if a slot is open it can't be filled case management process and I abbreviated abbreviated this act me assess client resources needs and goals we're going to go in there as case managers now we're not diagnosing or treating mental illness we're assessing their resources needs and goals we're going to collaborate with the client and
27:04
the team identify service plan goals and need us needed resources and we're going to put the plan together we're gonna collaborate on what this is gonna look like you're here at a1 you want to be at a ten what needs to change what needs to stay the same what needs to change what resources do you need okay now how are we gonna do this what do we need to do to get you to a - what does a - look
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like and then identify those objectives and those resources what does a 3 look like identify those objectives and those resources so you create this collaborative treatment plan imagine that and then you implement the darn thing you know that's great it's down on paper now we got to do it and just like anything else implementation of a treatment plan is not always people's favorite thing to do there are certain things they may have to do that they're like oh really I don't
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want to do that but it's important that they do it so a case manager can serve the other function of helping people maintain motivation helping them do things that they may be apprehensive about doing if they've got to ride the bus somewhere in order to make an appointment or if they've got to go see a dentist some people are really afraid of dentists case managers can be there to be a support system a cheering squad provide encouragement it can monitor people
28:38
for how they're doing and how well they're implementing things and if they see that the person is backsliding on their treatment plan implementation or their behaviors you know if their depression is increasing or they're you know obviously starting to not shower forgetting to eat something like that the case manager can monitor is monitoring and can intervene early and as things go along the case manager and the client and the team are going to work together to evaluate the
29:15
person's progress and see you know whether they're making the benchmarks that they had hoped to make whether that is reduction of inpatient visits or increased number of days attending work whatever the goals are primary case management functioning functions include positive relationship building with clients their families providers insurance companies and potentially community leaders effective written and verbal communication negotiation skills sometimes you
29:57
need to negotiate with clients to increase their motivation sometimes you need to negotiate with providers to you know get them to work as part of a multidisciplinary team I've worked with some providers before that are very resistant to having to communicate with a single point of contact they do their thing and they want to be left alone getting any sort of feedback is like kind of like pulling teeth knowledge of legal ethical and risk management issues regarding confidentiality
30:39
informed consent and any risks associated with that particular client if you're working with somebody with Alzheimer's you're going to be concerned about wandering and other things you want to know what risk issues are there that you need to be aware of other risk management issues can can include things like knowing if you if you refer somebody to somewhere and they start having a nurse come in or CNA come in what's the risk with that risk for elder abuse that may be going
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on you need to be aware of you know all of those things not saying it will but it could cultural responsiveness in all services is you know that's a primary function of you know counseling case management Social Work whatever we need to be able to work with the client and the rest of the team to develop goals enhance motivation and evaluate progress we're going to talk about different ways to measure progress in a minute you want to be able to promote client autonomy and
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self-determination we don't want clients and their families expecting the clinician to fix the client to expect the case manager to you know basically babysit the client and take them everywhere that's not what case managers do case managers are there to assist and facilitate and empower individuals to do what they can you need to have knowledge of funding sources healthcare services human behavior
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dynamics healthcare delivery and financing systems and clinical standards and outcomes if you're a case manager you're probably gonna pick a field or an area in which you work you may work with people with autism you may work with people with addictions you may work with people who have who have had kidney transplants you may work with people through hospice who have terminal cancer diagnosis whatever your little niche is you need to be fully aware of all of the resources
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and clinical standards and outcomes that exists so you can educate clients help them increase their health literacy and you can make sure that you're accessing and helping them access all of the resources that are available to start to gather information about all of these areas funding sources healthcare services etc the first thing pick your pick your specialty and then look and see if there's a national or state organization that works with that so the Autism Awareness
33:48
Foundation I don't know exactly what their name is but if you're working with autism if you're working with families with premature infants the March of Dimes you may start there to identify the needs that these particular clients may have and their families may have the resources that are often needed and then you can start calling United Way information and referral to find out about resources in your local area that might help them with durable medical equipment or even
34:22
electric payments if they're paying so much money for medical care that they're having a hard time paying their electric bill that's one of those places where a case manager can say okay this these are places where you can go I would also look to specialists in the area and start getting becoming aware of what specialists might exist I know for my son being a micro preemie he had an occupational therapist and a physical therapist and a I don't a case manager / some other kind
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of therapists that used to do home visits three days a week for about three months after he came home from the hospital if you are a case manager you want to have feelers out and you want to be aware of have relationships with the those types of providers in your area and then go online and start looking at best practices for addressing that issue if you are working with people with postpartum depression okay so let's start looking on PubMed go to PubMed and put in the key phrase
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postpartum depression start looking there or the cochrane database for currently reviewed best practices for addressing postpartum depression that'll give you some more ideas or information on clinical standards and outcomes that you may use as targets guiding principles you want to use a client centric comprehensive holistic approach you are not just there to help them stay on their medication you are not just there to make sure that they are taking a bath you want to
36:16
make sure that you're looking at all of their bio psychosocial needs you want to facilitate self-determination and self-care with advocacy collaboration and education it doesn't matter the level of intellect the IQ of your clients ninety nine percent of clients especially adult clients are going to be able to understand some level of what you're talking about there for you it's important to work with them to empower them to do what they can and to advocate for them collaborate
36:59
with them and make sure they feel like they have a sense of personal agency again remain culturally responsive promote the use of evidence-based care and I did mention the Cochrane Database earlier
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there we go enhance client safety
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is another thing that you need to do paying attention to what boosts that particular client might need in order to stay safe the Cochrane Library as I mentioned earlier just to kind of segue back back there you go to Cochrane Library com there's an advanced search and let's do let's just do depression la dee da dee da
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and it thinks for a minute and then there are 632 reviews of interventions for depression music therapy acupuncture different medications dietary supplements collaborative care let's just open that one you
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you
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it tells you about how they did the literature review data collection and analysis main results and then the author's conclusions you can read through all that or you can just jump down to the plain language summary which takes out all that jargon and tells you basically is is this an evidence-based best practice or is this really weakly supported in in the literature I love the Cochrane Database so but I digress um linked with community resources assist with navigating the
38:59
healthcare system it can be really confusing especially with Medicare I remember with my grandmother knowing what you had to do because you've got the gatekeeper that's the primary care provider for what things do you need a referral what don't you need a referral for who's gonna pay for what how do I know where I can go when you go to the hospital anymore you can't guarantee that every practitioner that sees you is gonna be on your provider plan so there's
39:28
a lot of stuff that gets very complicated and stressful when dealing with insurance so somebody who understands that can help people navigate it and relieves a lot of anxiety we need to maintain competence and practice promote quality outcomes and measurement and support and maintain compliance with federal state local organizational and certification rules and regulations if you are
39:57
certified then you a case management body then obviously you need to keep up your CEUs and everything but also just federal state local and organizational rules and regulations need to be followed you know not surprising the degree of complexity of case management varies based on the context of the care setting it can be a wellness or prevention setting it can be an acute setting like crisis stabilization or it can be a real rehabilitative setting for example a short-term
40:33
care facility where somebody may go after they have a hip replaced you may be thinking well you know I'm a counselor why would I work there well counseling has a really big place in short and long term care to address grief and depression and anxiety and social transitions and all that other stuff these people are still a motive if you will working in a rehabilitation facility as a case manager you can also help them navigate their transitions and make sure they have all
41:07
their proverbial ducks in a row for when they're discharged it also varies the complexity varies on the health conditions and needs of the patient and the population served as well as the needs of family caregivers such as critical care asthma renal care hospice care some people will need a whole lot more stuff and involved activity other people you know for example somebody who is discharging after a crisis stabilization admission may not need as much the reimbursement
41:44
method applied such as Medicaid Medicare workers compensation or other managed care also may affect the degree of complexity you may or may not be able to link with certain resources and reimbursement and paperwork can get kind of overwhelming sometimes but you know that aside
42:09
case management is not I don't want that to put you off the health care professional discipline designated as the case manager whether you're a registered nurse a social worker a physician a rehab counselor etc can also affect the complexity a person who has a physician or an RN as a case manager may have a more complex case or may be met more medically complex than something else but you know that's really kind of loosey-goosey I think it depends on the client themselves there
42:47
are a lot of clients who are in hospice who really don't require a whole lot of case management and then there are other clients who are on the phone you know every two hours practice settings just gonna go through this really quick hospitals long and short term care facilities outpatient mental health or physical health clinics like your you know walk-in clinics student health centers corporations a lot of corporations benefit from case management because it reduces their
43:23
employee absenteeism health insurance companies private case management companies jails the VA community behavioral health geriatric facilities hospice medical group practices life care planning organizations and disease management companies a lot of these we already talked about but I've seen in a lot of the groups that I'm in people saying you know I'm really starting to get burned out I want something to do part of the time I still want to see clients some but I want something
43:55
else to do to diversify my workload because I'm I'm starting to get exhausted you know looking at these things figuring out you know putting together a proposal for a larger corporation like where I live Cracker Barrel restaurant is based in in Lebanon you know that might be somewhere that I would approach to see if I could help them reduce their employee injuries and maybe insurance rates
44:21
if we could get a wellness program going roles and functions conducting a comprehensive assessment of the client's health and psychosocial needs including health literacy status and deficits and developing a case management plan collaborating collaboratively with the client and family or caregiver you know kind of like we do in in counseling planning with the client family or caregiver and the multidisciplinary team the payer and the community to maximize quality and
44:52
cost effective outcomes so this is again where we may be going to the City Council or the County Commission or the county county health department and identifying a gap in services or trying to negotiate a way to make services more affordable for our clients facilitating communication and coordination to minimize fragmentation educating the client caregivers and team about treatment options resources benefits psychosocial concerns etc so timely and informed decisions can be made
45:27
I have a friend right now who has a son who has you know pretty significant autism and you know when we're talking about the spectrum and he's not working with a case manager right now they don't have access to one which is making some of his anxieties a lot higher because he's worried that you know his son is never going to be able to live independently and he's not sure you know he's he thinks way ahead he is not he's not sure what's gonna happen to his son when he
46:00
eventually passes away and or if heaven forbid something happened to him a case manager would be able to help him create a plan to reduce some of that anxiety we want to empower the client to problem-solve by exploring options of care to achieve desired outcomes provide them that menu encourage the appropriate use of health care services and improve quality of care and maintaining cost effectiveness encouraging them to get help when they need it to you know take
46:31
care of themselves to not wait they've got to go to the emergency room you know assist the client and safe transitioning of care from a higher level to a lower level especially if they're going from residential to you know home or if they're going from the hospital to home striving to promote clients self-advocacy and self-determination and advocating for both the client and the payer to facilitate positive outcomes for all involved but if there's ever a conflict
47:02
the client is the one that you have primary responsibility to with advocacy you want to promote the client's self-determination informed and shared decision-making autonomy growth and self-advocacy regardless of the age of the client or the intellectual ability of the client this is important and you want to do the same thing especially if you're working with a child you want to make sure to involve the family and encourage their sense of self-determination and shared
47:39
decision-making autonomy growth and self-advocacy we need to educate other healthcare and service providers in recognizing and respecting the needs strengths and goals of the client sometimes professionals can providers can get into a rut where you know they've seen people who are wanting to get their meds renewed or whatever every 15 minutes for 40 hours a week for you know three months and all of them just start looking the same you know is another person with paranoid
48:20
schizophrenia it's another person with clinical depression and we want to make sure that providers are seeing that person as an individual facilitate client access to necessary and appropriate services recognize prevent and eliminate disparities and accessing care and outcomes this is really important as a case manager again if you are working in you know downtown Los Angeles
48:47
access is probably there's public transportation access is probably not as difficult as if you are working in the middle of rural Utah where there may not be there I'm sure there's not the same level of services and resources and transportation and access it's important that the case manager say okay well here's a problem you know we need to make sure that people can actually get to services whether that's through telehealth means or implementing public transportation or whatever
49:24
the case may be and we want to advocate for the expansion or establishment of services and for client centered changes in organizational and governmental policy one of the clinics I worked at one of the changes they kind of had to make when they went to capitation they had to make sure that any client who called for a mental health assessment was able to be seen within 48 hours period it's not 2 working days it was 48 hours well that kind of threw us in a tizzy and
49:59
we had to redo some of our standard operating procedures however it enabled clients to get services when they needed them go figure when they were in crisis we also because we didn't have enough clinicians to see all these people one on one instituted intervention level groups so people who were on the waiting list for individual therapists would be able to attend groups up to three times a week they were able to step in start getting services start getting psychoeducation
50:34
at the very least in order to help them feel like they were getting help and help them develop that hope there were a lot of clients and I can't tell you what the percentages were right now but there were a lot of clients who completed treatment and discharged before they went to see an actual individual counselor so it saved money it saved time it got clients in when they needed it it made
51:03
sure that they weren't just seen for an assessment and then okay our first appointment is six weeks from from Monday well that doesn't do me any good so we were became much more client centric client selection you want to look at the duration of the diagnosis people who've recently been diagnosed are gonna have a lot of questions and really not know about a lot of resources if you're working
51:27
our farrier son has multiple sclerosis and is you know older they've been dealing with that for you know nearly twenty years now they know in general what the resources are in this community they need less assistance case management wise then somebody who just had a child that was diagnosed with multiple sclerosis the level of pain control can also be an issue that indicates a need for increased case management services people who don't have well controlled pain are
52:05
at higher risk of opioid overdose substance misuse physical health problems high blood pressure a lot of things we want to help them get that pain under control not as their early through medication but functional status or cuz it is leading or having difficulty you know thinking through the things they need to do on a day to day basis they may need some intervention one of my friends brothers was had schizophrenia and he lived in an assisted living situation
52:44
for people with severe and persistent mental illness but he would regularly forget to eat and bathe and that was that's a problem you know those are those are big problems for his overall health and well-being so targeted case management was important for him if the person has had a lot of previous home health and durable medical equipment usage then they may need case management if there's a history of mental illness or substance abuse suicide risk or
53:15
crisis intervention that's a risk factor that may indicate the person may benefit from some case management it doesn't mean you're gonna have to have case management three times a week but it may be nice and it may be helpful to have a case manager that connects with them by phone once a week or once a month to make sure that their transition goes smoothly if the person has had a chronic catastrophic or is diagnosed with a terminal illness obviously that's something that
53:49
requires adjustment chronic illnesses generally progress or they have EDS and flows and there may be periods where they need more case management like if they have lupus social issues such as a history of abuse neglect no known social support or lives alone can put them at a higher risk for service utilization and negative health outcomes if they've had repeated treatment admissions then you know we know that they're having a hard time continuing on that positive path after
54:23
their after their treatment ends so they may need somebody that's there to keep them going keep them going forward and if there's been need for admission or transition to a post acute facility then case management obviously as we've talked about a lot would help ease that transition
54:44
opportunities for an intervention if there's a lack of established evidence-based plan of care with specific goals then obviously we want to step in and go okay let's sit down and really define where we're going with this if the person over utilizes services we can look at what's the benefit to them of service utilization is and you know why are they going to the emergency room all the time versus something else versus you know a primary care and sometimes it can be because
55:20
they don't have insurance to cover primary care and they know the emergency room has to treat them that's a problem we need to look for free and low-cost health clinics if there's under utilization of services we may need to educate the client about resources that are available and figure out why they're underutilizing are those services not culturally responsive do they not feel heard are they afraid they can't afford it what's keeping them from utilizing
55:48
those services and then obviously you want to chart appropriate utilization of services use of multiple providers and agencies you know some people need multiple providers and agencies because they've got complex issues but intervention isn't necessarily reducing the number of providers and agencies but coordinating and making sure that they're not overusing any particular provider agency and the treatment is integrated make sure they're using appropriate
56:26
services or levels of care like in the example I used earlier you don't want somebody going to the emergency room for an earache what other options do you have that the person can access non adherence to a plan of care case managers are great at helping people keep moving forward case management as I said can be done preferably not exclusively but your interim you know your touch bases between face-to-face visits can be with a five-minute phone call lack of education on
57:01
the clients part or understanding of the disease process their current condition the medication list or provider treatment plan especially when my mother was undergoing chemotherapy wow that treatment plan was really complicated and she never got the answer to why certain things were happening the doctor just said this is what we're going to do and be gone with you case managers would be able to help answer those questions and advocate for the client medical psychosocial
57:35
mental health or other functional limitations are also great areas for case managers as case managers if somebody has emotional and cognitive needs whether they have autism ADHD paranoid schizophrenia whatever depression we can make referrals for counseling and help them be aware of the different best practices for treatment including medication for some you know I'm not a fan of medication but for some it may be necessary physical needs making sure that they are able to
58:12
get adequate sleep nutrition safe housing they're able to get their medical needs met they're you know co-occurring type diabetes and high blood pressure and all that kind of stuff because we know that all impacts mood as well as health and safety so that bottom level of Maslow's hierarchy social needs making sure they have access to social support they're not just out there all by themselves they have interpersonal skills and child or respite care as needed ace managers can
58:45
help connect people local Area Agency on Aging or your you know there can't there are day programs I hate to call them day care because that sounds so condescending day programs for people who are older who may live by themselves and need that social interaction vocational needs case managers can connect people with job coaching help them learn about reasonable accommodations and the job accommodation network or Jan which is online employment or meaningful activity we all need to
59:19
engage in meaningful activity on a daily basis that helps us feel happier content purposeful and environmental needs like transportation case managers can help people figure out how they're going to get to these medical appointments how they're going to get to the grocery store etc we can also look at patterns of care or behavior indicating worsening of the condition you really want to get a case manager in there as quickly as possible so you don't have to increase the
59:51
amount of clinical services case managers can help prevent inappropriate discharge or delay of discharge from other levels of care they can advocate for the client and say you know what we don't have everything ready you know Jim Bob needs to stay in for another week or another day whatever it is and if the person has frequent transitions between settings they go from the hospital to short-term care back to the hospital back to short-term care we may want
1:00:21
to look at why that is and help the person find somewhere where they can stop having to bounce around case manager qualifications include a current active and unrestricted licensure or certification or baccalaureate or graduate degree and Health or Human Services which allows the professional conduct an assessment independently as permitted within the scope of practice of the discipline so if you're licensed or certified as a case manager then you're just
1:00:53
going to be assessing needs and resources and screening from mental health physical health or addictive issues if you identify a need for that to be further assessed then you're going to refer out to a clinician this license to do that the demand for case managers is growing rapidly as insurance companies restrict reimbursement move toward capitation and as individuals start to have higher co-pays and try to reduce expenses not only our case managers employed by hospitals and
1:01:21
treatment centers but Inc by organizations like businesses and universities that have a strong motivation to keep their employees and students healthy and relatively happy case managers provide assessment advocacy education and assistance with treatment coordination and implementation often in a multidisciplinary team but again remember case managers do not diagnose or treat any illness
1:01:52
we're done thank you for staying with me today does anybody have any questions and I saw somebody talking about the stigma about
1:02:04
paid case managers hired contract case managers versus organizational case managers if you will and
1:02:17
it is an interesting topic where I came from where I've worked there really hasn't been that much of a stigma because the private pay case managers were taking care and providing services to people who otherwise would not get case management services because they didn't qualify for insurance reimbursed case management so there really hasn't been and competition for resources in that particular area that doesn't mean that it doesn't exist and yes there was
1:02:59
a little bit of resentment on the part of organizational case managers just because the private pay case managers were getting paid more that wasn't really so much stigma as you know a financial social issue thank you for listening to case management toolbox podcast go to all CEUs com slash case management to access the CEU course for this episode you can also subscribe to case management toolbox podcast to be notified when new episodes are released
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