Case managers become bigger factor in primary care

Nurses and other health care workers are coordinating services within accountable care organizations and patient-centered medical homes.

By — Posted May 30, 2012

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The third annual Healthcare Case Management e-survey of 153 health care organizations released May 14 by the Healthcare Intelligence Network found that 90% used case managers in 2012. The number is comparable to previous years, but the proportion working in the primary care setting grew from 14% in 2011 to 58% in 2012.

Case or care managers are considered a key part of patient-centered medical homes and accountable care organizations. They coordinate care and provide patient education about disease management and the signs indicating a need to call a physician. The case manager also may make referrals to community resources that can address social and financial concerns.

“It’s usually more information and support than what physicians can give patients in a 15-minute visit,” said Charlene Schlude, RN, director of care management with CDPHP, a physician-owned health plan based in Albany, N.Y.

The intention is to reduce emergency department visits and hospital admissions as well as improve outcomes. Case managers usually are funded by an insurer or large health system, but some medical practices may hire one directly to coordinate care to earn incentives. They usually are registered nurses but may be another type of health care professional.

People who run case management programs say the biggest barrier to embedding one in a practice is the lack of a HIPAA-compliant area where one can work with patients in person or by phone. Those embedded by outside organizations may be called upon to fill in for practice staff, which may not be appropriate.

“Practices are used to using everyone for everything,” Schlude said. “But embedded case managers should not put patients in a room, and they should not pull charts.”

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