Proactive Case Management
by Mildred Simpson, RN, CCM

Every day, 7,918 people reach the age of 60, according to 2006 Census projections. Many of them miss opportunities to improve their health because they do not fit into the typical complex case-management program. To overcome this challenge, we designed a pilot program that encourages individuals to be proactive and lead healthier lifestyles for a better quality of life.

Many Baby Boomers feel they are healthy because they work and probably have had no inpatient hospitalizations, and no use of home care services or durable medical equipment. But as part of the Sandwich Generation — adults “sandwiched” between caring for their aging parents and their growing or grown children — they overlook their own healthcare needs and instead choose unhealthy behavior patterns, which could eventually put them at risk. They may also have certain diagnoses or diseases.

The focus for this group of people should be preventive medicine, according to Healthy People 2010, a national initiative. Earlier contact with the healthcare team would have a beneficial effect for this group, resulting in a healthier lifestyle and improved quality of life. To do this, we developed a proactive program to reach out to this population.

Expected to rollout in late spring 2007, our six-month pilot program will target a defined group of people that has the most potential for future risks and high costs. For example, intervention for an overweight individual who has a strong family history of cardiac disease and hypertension, a poor diet and a sedentary lifestyle could result in a positive outcome with the person making a conscious decision to change their unhealthy behaviors.

The program’s approach is two-fold: to work with each individual to identify their motivation to change current behavior that could influence future problems and to provide information needed to make wise decisions. Motivation to change, which we based on the Case Management Adherence Guidelines Version 2, is necessary to work through any barriers that might prevent the individual from choosing healthier behavior. The program focuses on the individual’s responses and choices in collaboration with his or her case manager and physician.

The program will establish a win-win situation by working with people in their current condition and creating a desire to work with the case manager. If the person is interested, the case manager will assist the individual with any immediate issues or concerns. After establishing a rapport with the person, the case manager will arrange appointments to discuss other issues and to ask survey assessment questions.

The program has nine domains (surveys) with questions specific to this group of people. How the person answers the questions determines the results, which will populate an action plan with issues and goals. In addition, the survey answers provide a numerical value, which should move from a higher to lower number over time as the individual shows positive outcomes from the program.

This is a very exciting opportunity and another way to enhance case management skills.