Case Managers can make a major difference in outcomes
Faye Martin Liner, B.S.
Case Manager, PPCP PCMH Division
The Case Manager’s (CM) Role
‰ Integral in helping the patient achieve self‐management of their condition
of their condition.
‰ CMs have a unique relationship with the patients, the doctors and other care providers, as well as with community age c es t at ca be e t t e pat e t.
agencies that can benefit the patient.
‰ Proactive Scheduling
10% increase in the number of visits ¾ Improves outcomes
¾ Helps avoid acute episodic events
¾ Strengthens patient‐provider relationship
‰ Act as a liaison between the provider & the patient
‰ Ensure evidence based process & outcomes measures are met
The Case Manager’s Role
‰ Provide personalized care to help meet individual needs & improve patient satisfaction, for example:
improve patient satisfaction
for example:
¾ Educational Materials (print & online)
¾ Pharmaceutical Vouchers & Samples
¾ 10 Day Gym Passes & Discounted Memberships
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¾ ADA Approved Cookbooks & Nutrition Guides
¾ Access to Glucometers & Strips
¾ Community Assistance Programs
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CM INTERVENTION
‰ CMs multi‐component interventions include
¾ Self‐management education
¾ Home visits
¾ Telephone call outreach
¾ Telemedicine
¾ Client reminders. ‰ Engage patients care self‐management Motivational Interviewing
Motivational Interviewing
¾ CMs asks questions and act as partners in dialogue rather than giving advice or instruction.
¾ CMs makes the patient feel comfortable examining all aspects of the behavior, including their own mixed feelings about change. ff
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Effectiveness of Motivational Interviewing
According to the Harvard Mental Health Letter, its uses are g
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not necessarily restricted to formal counseling, and it can be incorporated into a wide range of programs for brief treatment and prevention of psychiatric disorders and other health problems.
other health problems
What fits your busy schedule better, exercising one hour a day or being dead 24 hours a day?
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Be Sensitive
The CM tailors discussions to patient demographic. You have to act sensibly, eat the positive, eliminate the negative, and don’t mess with Mr. Sugar i h M S
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Patient approach must be non‐threatening, non‐
th t i judgmental, and compassionate.
Mr. Dillon’s Story
¾ Age 51, correctional officer, type 2 diabetes for 12 years
¾ On worker’s compensation following inmate assault. k ’
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Recent surgery coupled with depression over job situation and physical disabilities. ¾ Angry and frustrated over employer treatment after injuries. Uncertain of job future. On 2 anti‐anxiety meds, 2 oral meds plus insulin for diabetes, 4 hypertension meds and insomnia meds. Not checking sugars as directed, poor diet, home all day alone. ¾ A1c of 10.2. Does not exercise due to physical limitations. Mr. Dillon’s Story
Addressing the Tipping Points: 1 ‐ Depression
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2 ‐ ”No Big Deal”
3 ‐ Inevitability
4‐ Treatment Skepticism
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5 ‐ Unrealistic Plans for Action
6 ‐ Poor Social contact
77 ‐ Environmental problems
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In discussion with the patient, clearly his situation is complicated by his diagnoses of multiple health issues, worries about his personal employment/health/financial f
future, and unrealistic action plans. He simply doesn’t deal d
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with his situation. Helping Patients Succeed is an Art!
Assess the Patient’s Needs
Getting him to agree he needs to change behavior is vital.
Help him prioritize
He needs to check sugars as directed. He needs an eye exam. He needs an exercise plan.
Help him make a plan and plan to succeed
Patients need to take responsibility of their care management and ownership of the plan to get there. Suggest, encourage but don’t do it for them!
Be realistic about what will work
Don’t just suggest that he join a gym. Cost and time are often issues. Help him find alternative locations where and when he can exercise. i ¾ Walk in the neighborhood or local Mall.
¾ Inexpensive YMCA membership.
¾ Join a local senior center where class is held. ¾ Enlist a friend or spouse as a “work out” partner.
¾ Chair exercises with exercise bands we provide from DME companies
Improving Outcomes
¾ Mr. Dillon’s A1C is now 7.4
¾ Walking for exercise
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¾ Has greatly reduced smoking
¾ Testing sugars, taking meds as ordered
¾ Working with an employment attorney to return to limited duty
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Motivate the Patient
Clients fail to comply with medical treatment for a variety of reasons
¾ Inability to afford medications, failure to appreciate the seriousness of their Inability to afford medications failure to appreciate the seriousness of their condition, mental health issues such as depression, and an unsupportive family are a just few examples. Assess the Situation
¾ Understand why your patient is noncompliant. Can he afford medication? Does he understand instructions? Is he depressed? Pinpointing the reason will help you find a way to your patient.
Look for signs that your patient may need special attention to follow the t
treatment regimen.
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Is she following her diet guidelines or gaining weight? Does she keep office appointments or is she often a no‐show? Has she had multiple incidents of disease crisis? These are signs that you need to try harder to reach your patient.
Assess whether your patient is satisfied with his care.
¾ Unhappy patients are less likely to comply with treatment. Ask about his satisfaction with the customer service aspects of your practice as well as any y
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issues he may have with the medical staff. Address any concerns.
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Encourage compliance, set goals, provide tools and resources
¾ Each person has an internal set of pros and cons that influence behavior. ¾ Find out those factors, keep the goal in mind, which is getting patients to take their medications to make changes such as losing weight. Auburn University (2007, July 26). Patient Compliance Improves Through 'Motivational Interviewing'. Science Daily. Retrieved September 20, 2011, from http //
http://www.sciencedaily.com‐ sciencedail com /releases/2007/07/070721194716.htm
I don’t think that is what your doctor
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Meant by lowering your carbs, honey
MSOffice1
Diabetes Self‐Management Education
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Interventions (DSME)
¾ Talk with the patient about attending diabetes education. Be prepared for objections and excuses! ¾ The goals of DSME are to optimize metabolic control, prevent acute and chronic complications, and achieve an optimal quality of life, while keeping costs acceptable.
I think that went rather well for the first time
Slide 15
MSOffice1 The goals of diabetes education are to ooptimize metabolic control,
to prevent acute and chronic complications,
and to achieve an optimal quality of life while keeping costs acceptable
, 9/20/2011
Collaboration with Providers
¾ Building meaningful relationships with providers as part of the Medical Homes Team is vital to complete the circle of support.
¾ Communicate (EMR) with information discovered during patient C
i t (EMR) ith i f
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d d i ti t contact. Relay concerns, questions and needs from patients. ¾ CMs can schedule follow‐up visits, lab work and message the p
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office for Rx refills or other needs. ¾ Have regular meetings with providers to provide data, feedback and learn provider preferences.
and learn provider preferences
Patients are eager and grateful for our support.
CMs reach out to CM
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community organizations that enhanced our patient support.
Case Management is vital to PCMH
Case Management is a skill, it is a calling, it is an art. Reaching out to patients and their families is a vital component of the PCMH model. Choose your CMs as if you were choosing someone to assist with care management of a loved one. Your PCMH Model will be rewarded with better outcomes, a cohesive team, and healthier patients.