2. TRANSFORMING YOUR
CASE MANAGEMENT’S
Length of stay
Claims management
Clinical outcomes
Successful case management requires collaboration among case
managers, social workers, nurses, and many others in a position
to impact the timeliness and appropriateness of care delivered
to patients.
By helping your hospital look at the interrelationship
of all actions that impact a patient’s progression along
the acute-care continuum, HCT can help you create a
more proactive approach to managing the process.
We can help you:
• Reduce lengths of stay, where appropriate
• Increase the rate of payor authorization and
reimbursement
• Improve patient care outcomes
3. Length of stay:
HCT helps you transition your case management model from utilization review and
discharge planning to care facilitation. Often this involves improving communication
among staff, making changes to work flow or work assignments, and utilizing better
patient tracking systems. It means working not only with staff, but engaging physicians
in the process of providing timely patient care, documentation, and discharge.
Payor compliance:
HCT performs an in-depth analysis of financial performance relative to payor
requirements, including Medi-Cal and Treatment Authorization Records (TARs). One
of the hallmarks of the HCT case management program is its approach to Medi-Cal
and denials management. Combining techniques to improve physicians’ and case
managers’ documentation, with a proactive, aggressive approach to case management,
has allowed HCT to effect a reduction in denials by as much as 15%.
Clinical outcomes:
Taking a more proactive approach to case management can create better clinical
outcomes for patients and prevent “never events.” During the process of reducing
length of stay, improving collaboration among staff, and examining appropriateness
and timeliness of care, we help you increase your performance in meeting evidence-based
quality, safety, and care goals.
Measurable results:
e graph below provides an example of the success made in reducing Medicare LOS
in a 220-bed facility.
ALOS 220-Bed Facility
6.0 Implementation
5.0
4.0
3.0
2.0
Q1 Q2 Q3 Q4
2005 2006
4. HealthCare Transformation, LLC
70 West Madison Street
Three First National Plaza Suite 1400
Chicago, IL 60602
T- 312 214-7216
F- 312 214-3110
www.hctconsulting.net
