HCT Consulting Was Approached by a 350 Bed, Full-Service, For-Profit Health Care Provider with the Desire to Totally Revamp Their Case Management Department

The provider felt they were not staffed appropriately and were operating like a case management department “out of the 1980’s.”

Chicago, IL, September 12, 2008 --(PR.com)-- HCT Consulting was approached by a 350 bed, full-service, for-profit healthcare provider with the desire to totally revamp their case management department. The provider felt they were not staffed appropriately and were operating like a case management department “out of the 1980’s”.

The initial objectives discussed were:

Provide breakthrough analysis and deep analytical support to selected initiatives:
Introduce expertise, approaches and specific knowledge in selected areas while accelerating implementation in key areas;
Provide day-to-day program management support; and
Achieve and sustain the performance impact in the areas of case management (department structure and operations), Medicare LOS and interdisciplinary interactions.

They used their unique Transformation Intervention TM process to conduct the assessment, process redesign & staff training as well as implementation and performance measurement.

The assessment phase consisted of observations, shadowing, interviews and data analysis. The targeted areas were departmental infrastructure, education, barriers to discharge and technology. Also, as a part of the assessment, they were asked to interview potential candidates for the interim Case Management department director position and to conduct an objective performance rating of all case managers and social workers in the department.
The redesign & staff training phase consisted of brainstorming sessions which included case managers, social workers and nursing. A product of this phase was a Collaborative Action Plan that was immediately implemented. In addition, a needs assessment was conducted to identify training and other educational gaps of the department.

The newly developed action plan was put into place under the guidance of the HCT consultants. Some key initiatives for departmental infrastructure included:

Identification of new case management director;
Transition to unit based assignments;
Delineation of case manager and social workers roles and responsibilities;
Engagement of a proactive physician leader;
Establishment of an ED case manager; and
Creation of a new departmental escalation policy.

Key initiatives for education included:

Lining up in-services for case management department to be conducted as “lunch and learns”;
Education of unit secretaries and HIM on importance of correct discharge dispositions;
Ongoing nursing education;
Community education which included meetings with nursing homes, SNFs and LTACHS; and
Utilizing the Physician Leadership Director to conduct ongoing physician educational sessions.

To tackle some of the barriers to discharge, the tactics included;

Establishing multidisciplinary daily huddles;
Helping case managers and social workers to re-prioritize their day;
Restructuring the complex case review meetings;
Working closely with Hospitalists to establish responsibility and accountability for medical staff; and
Implementing a concurrent coding process.

In the area of technology the focus was:

Researching automated case management systems (including discharge planning); and
Establishing access for all the case managers to KePro I- Exchange and setting the expectation for daily tracking for Medicaid approvals.

For the performance measurement phase they worked very closely with the Quality/Performance Improvement department as well as the IT department to establish an extensive dashboard on the facility’s shared drive, allowing the tracking and trending of measures as well as providing easier access by the Administrative team.

The hospital was able to make major changes in a short period of time with the potential of a significant financial impact. The hard savings which were realized rapidly were part of the department FTE restructure and resulted in a savings of approximately $200,000. The at-risk reimbursement that was corrected by establishment of new processes will save the facility $950,000. As a result of changing the delivery model for case management and implementation of initiatives the facility committed to reducing Medicare LOS by 0.5 days. This results in a “soft” savings of between $415,000 and $975,000. The total financial impact for this engagement ends up between $1.5M and $2.1M.

This facility is serious about sustaining the progress they have made and continuing to build on that progress. They are still actively implementing improvements and are working very closely with HCT to help ensure ongoing success.

HCT Consulting
Jacob Kupietzky