International Consulting 2005 CareMap(R) Tour 2005.

The Problem (one or more may apply):

• The executive team is not seeing expected financial or quality results.
• The physicians are not on the same page as the administration.
• Front-line managers of professional and department services are frustrated.

The Process:

• Review of related data prior to onsite.
• Onsite visit for 2-6 days (depending on size and complexity) by team of niche experts from the field.
• Team lead by CCM Principal or Senior Consultant.
• Typical team includes MD, SW, Administrator, RN, Case Manager.
• Interviews, observations, meetings with key people and groups.
• Observations and chart review in the clinical area.
• Provide information and assistance as needed during the visit.
• Build positive relationships that set the tone for future implementation.

Deliverables (negotiable):

• Brief exit meeting if requested.
• Written report with assessment, recommendations, tools and examples.
• Follow up visit for strategic planning and determination of next steps.
• Phone support via appointment for one year following the visit.

Client example:

• A large academic medical center in the South sought CCM's help to evaluate how operations under its six vice presidents contributed to financial and quality outcomes. Following a five day assessment, observations and meetings with over thirty key people, CCM provided recommendations encompassing the business office, physician leadership, outpatient relationships with the medical center, case management, professional nursing services, home care scope and CQI initiatives. The vice presidents continue to use the guidance of CCM.

The Problem on the Provider Side (one or more may apply):

• Margin is not meeting mission
• Results are poor, slipping, or vulnerable due to new regulations and market issues: Denials, LOS, CMI, Cost per Case, readmissions, patient/family satisfaction.
• The patient's journey through acute and post-acute care is not planned or managed.

The Process

• Review of related data prior to onsite visit.
• Onsite visit of 2-6 days (depending on size and complexity) by team.
• Team composed of experts from the field.
• Team lead by CCM Principal or Senior Consultant.
• Typical team includes Case Management Director, MD, SW, Case Manager.
• Review of Emergency Departments.
• Review of Social Service.
• Interviews, observations, meetings with key groups and individuals.
• Observations of events in the clinical areas (discharge planning rounds, etc).
• Chart review.
• Provide information and assistance as needed during the visit.
• Build positive working relationships that lay the groundwork for future implementation and training.

Deliverables (negotiable):

• Brief exit meeting if requested.
• Written report with assessment, recommendations, helpful tools and examples.
• Follow up visit for strategic planning and determination of next steps.
• Interim Directors of Case Management provided for short term as needed.
• Phone support via appointment for one year following the visit.

Client Response:

• "These were the first consultants we have had that really know what they are doing at the level of detail where we were having problems. Because of their suggestions, our Medicare LOS is already going down, the physicians have become more responsive to us, and we have the ability to work on our other targets." (from Executive Team of Vice-Presidents at a community hospital in the Midwest).

The Problem on the Payer Side (one or more may apply):

• Margin is not meeting mission.
• Results are poor, slipping, or vulnerable to new regulations and market issues: LOS, CMI, Cost per Case, admits per 1000, readmission rate, patient/family satisfaction.
• The patient's journey through acute and post-acute care is not planned or managed.

The Process

• Review of related data prior to onsite visit.
• Onsite visit of 2-10 days (depending on size and complexity) by team.
• Team composed of experts from the field, including an MD.
• Team lead by CCM Principal or Senior Consultant.
• Interviews, observations, meetings with key groups and individuals.
• Chart review.
• Provide information and assistance as needed during the visit.
• Build positive working relationships that will lay the groundwork for future implementation and training.

Deliverables (negotiable):

• Brief exit meeting if requested.
• Written report with assessment, recommendations, helpful tools and examples.
• Follow up visit for strategic planning and determination of Next Steps.
• Phone support via appointment for one year following the visit.

Client Example:

• A large insurance company with multiple product lines, including an HMO, engaged CCM in an assessment of its case management-related operations. Among other activities, CCM consultants went on site visits with case managers, reviewed records, interviewed financial and medical VPs and conducted patient focus groups. The company received recommendations with three options that could be implemented individually or in progression. The director of case management refers to the report as her "Bible" and after two years it continues to guide her in developing the department to meet financial and quality targets.
• CCM consulted with a state Blue Cross/Blue Shield Plan to recommend and provide curriculum for UR and Catastrophic Case Managers and Physician Advisors. A series of 8 sessions highlighting case management processes for large volume, complex populations, responsibilities, and results was provided. The series served as a positive base while the company experienced other change.

The Problem (one or more may apply)

• The nursing shortage has created a crisis in direct care.
• Nursing is rethinking and revising its professional practice models.
• Nursing knowledge, skills, and values require re-charging.
• Continuity and accountability are missing or absent.
• There is no "plan for the day" for each patient.
• Nurse managers require development.
• Use of LPNs, aides, unit clerks, and ancillary staff is inconsistent and does not enhance nursing productivity.
• Patient/family or MD satisfaction ratings of nursing are lower than expected.

The Process

• Review of related data prior to the visit.
• Team lead by CCM Principal or Senior Consultant, each with deep knowledge of building nursing models that support continuity of care and accountability for outcomes.
• Onsite observations, meetings, and interviews with key groups and individuals.
• Team size and number of days depends on size and complexity of organization.
• CCM specialties are intensive care, renal care, cardiology and telemetry, psychiatry, general surgery, general medicine, geriatric care, primary care and outpatient.
• Build positive working relationships that lay the groundwork for future implementation and training.

Deliverables (Negotiable)

• Exit meeting if requested.
• Written report with assessment, recommendations, helpful tools and examples.
• Follow up visit for strategic planning and determination of next steps.
• Phone support via appointment for one year following the visit.

Client examples:

• The client was a small hospital in the rural Northeast experiencing high nursing turnover, lack of treatment planning, and low confidence in nursing by the MDs. CCM developed a continuity of care model that ensured the availability of experienced nurses to the patient and MDs 7 days a week. The new model was integrated into the clinical ladder, job descriptions, and performance evaluations.
• At a large hospital with magnet status in a mid-Atlantic state, the roles of nursing leadership, case management, and social workers were clarified and enhanced by CCM. CCM uses the ANA's standards for outcome-based practice to clarify a strong nursing role within the context of other professionals.

Definition: Clinical Integration and Programs of Care are formal methods to provide patients and families with a smooth journey throughout the health care system. Clinical Integration and Programs of Care involve the restructuring of clinical and administrative processes so that both quality and financial objectives can be met consistently and professionally. They take product line management to the patient care level on one hand, and the community level on the other. CCM staff has written a text: Mary Tonges (editor), Clinical Integration: Strategies and Practices for Organized Delivery Systems (1998) San Francisco: Jossey-Bass Publishers.

The Problem (some or all may apply):

• The integrated delivery system is not performing as expected.
• Each part of the system is acting like a stand-alone entity.
• There are many inefficiencies in administrative and operational functions.
• Patients are not experiencing a smooth journey through the health system.
• Local primary care physicians and hospital-based physicians are not aligned.
• Evidence-based practice has not been a priority.

The Process

Review of related data prior to visit, including community and public health data.
• Onsite visit of 5-10 days, depending on size and complexity of organization.
• Evaluation of each segment of the enterprise as well as the leadership of the system.
• Team lead by CCM Principal or Senior Consultant.
• Build relationships that will promote learning and a framework for moving forward in the future.

Deliverables (negotiable)

• Written report with assessment, recommendations, and tools and examples critical to understanding of current state.
• Follow up visit for strategic planning and determination of Next Steps.
• Phone support via appointment for one year following the visit.

Client examples:

• CCM conducted a hospital-community-county survey in upstate New York to assist a client in the development of improved relationships with community agencies and physicians. The hospital established a position of Senior Director, Continuum of Care. In collaboration with the community, the hospital also initiated 12 Programs of Care defined by the primary diseases and services present in the region, and continues to integrate the care of patients through monthly meetings that develop evidence-based practices and practice changes.
• When a hospital in Pennsylvania needed to strengthen its cardiac product line, CCM provided national cardiac experts on site, and then brought the entire leadership team to a benchmark hospital with a similar population. For two days, the CEO, CMO, VP of Nursing, interventional cardiologist, Director of Cardiology, Nurse Manager of Cardiac Unit and Director of Quality learned first-hand how to strengthen their program clinically and financially. They left as a collaborative group with a shared vision, benchmark targets and the tools and knowledge to achieve them.

The Problem (one or all may apply):

• Managed Care Contracts create risk for utilization of extensive resources.
• The organization may be the payer or the provider.
• The organization has made a commitment to support the community and region.
• Data reveals serious problems or opportunities in the care of specific populations.
• The organization requires additional content/consult support for grants.

The Process:

• Review of data prior to onsite visit.
• Onsite visits dependent on size and complexity of organization.
• Team lead by CCM Principal or Senior Consultant.
• Team includes experts in the specialty from the field.
• Client provided with examples from other organizations identified by CCM.

Deliverables (negotiable):

• Assessment and planning phase: Written report of current state and options for providing health and disease management infrastructure: Goals and evaluation methods, FTEs, policies and procedures, etc.
• Implementation phase: Management of the project by CCM, training, supervision, development of clinical documentation and management tools, etc.
• Evaluation: based on parameters determined at the onset.
• Phone support via appointment for period of one year from initial visit.

Client examples:

• When a large HMO had goals to develop disease management software and an initial program for the disease management for asthma that reduced ER visits, it engaged The Center for Case Management. CCM interviewed, trained and supervised case managers who conducted telephone and home visits and provided recommendations for the use of home monitoring and computer use by patients. CCM also licensed its Self-Management Algorithm for diagnosing and managing patient adherence to the software company. After implementation, ER visits were reduced as planned because of improved patient adherence and enhanced use of technology.
• CCM developed standards of care for the five largest case-types cared for a company providing post-acute services in several states. The standards and principles of rehabilitative recovery were integrated with the best practice indicators from medicine, physical therapy, occupational therapy, speech and language, and nursing. The standards were adjusted for each level of care for each condition (such as COPD), and could be easily used with OASIS (home care), FIMs (in Rehab facilities), MDS (in SNF facilities) assessments.