Care Progression: Care Management Alignment

摘要

Health care organizations continue to struggle with the changing reimbursement methodologies that continue to transform the way health care is delivered. Historically, care management (case management, social work, and care transitions) programs have been focused on how to safely transition patients/ residents/clients to a different level of care through an established discharge planning process. Today, case managers must also have an increased awareness with regard to the quality of care provided by the accepting organization and whether they are part of an approved network. Risk-sharing arrangements are becoming more prevalent, and care management is a focal point. Organizations are beginning to embed revenue cycle and managed care contracting components within their care management domain. Predecessor case management programs truly focused on the revenue cycle to qualify the patient and discharge planning once the patient no longer qualifies for inpatient from the financial perspective. Traditional silos within care management, contracting and finance departments are now required to collaborate in order to effectively manage the transitions of care.