How the Case Management Process Helps Vassar Brothers Medical Center
by May Mamiya

“It’s all about talking. . . .”

On any given weekday, the 20 or so case managers in this acute care facility can be heard:

• sharing information on a patient’s family support during rounds with ICU physicians
• detailing reasons why continued stay in an acute care facility is justified according to criteria set by insurer
• consoling elderly patient admitted with chest pain shortly after loss of spouse — and gently beginning exploration of alternative living situations
• advocating for quick processing of application for financial support for young patient with complex medical problems
• providing information to discharging physician on medications covered by patient’s insurance plan — to insure prescribed follow-up care is affordable
• offering suggestions to frustrated nursing staff on how to deal with unreasonable demands of needy patient
• asking staff in the imaging department to schedule a test earlier so a discharge might be expedited
• responding to inquiries from the business office about denied days from an admission the month before
• collaborating with representatives from area home care agencies about how to improve referral processes
• discussing with families the resources available for supporting them in their wish to take their relative home to die
• answering questions from the chief financial officer about numbers of and reasons for surgical delays
• meeting with an pre-op patient about how (and why) to fill out a health care proxy
• addressing a community funding group about why a proposal for a music therapist to serve patients and families in the neonatal intensive care unit is important
• leading a weekly support group for patients living with cancer — or children with diabetes
• participating in care-planning sessions with other members of the neurological support team
• contacting colleagues in a hospital in another state to explore options for rehabilitation services in that area, so a patient can move closer to family
• reminding a physician in his office about the importance of a timely evaluation and completion of forms to expedite a transfer to another facility
• calling a colleague for up-to-date numbers for an infrequently used resource (while waiting for a call back on a new referral)
• interviewing a suspected victim of domestic violence in the emergency department; finding clothes and a ride for another in the same location

What do such conversations reveal about case managers?

Our conclusions:

1. they are seldom bored!
2. they have to be excellent communicators
3. they need to know the power of statistics, gather and use them well
4. they need (also) to be intuitive in their approach to others – patients or staff
5. curiosity helps — because sometimes they have to act like detectives
6. resilience is important (advocacy can be exhausting at times)
7. collaboration is essential: none of this can be done alone
8. a good sense of humor makes everything a little easier, and
9. they are critical to efficient patient flow, high quality care, patient and family satisfaction with services, good financial outcomes and program innovations.