Today’s healthcare system is undergoing fundamental changes. From care delivery to payment models, the system is transforming the very nature of the care continuum. Healthcare organizations are under intense pressure to decrease cost, improve quality, and measure and report on outcomes. This includes analyzing the ROI of case management.
According to the Jose Alejandro, current president of the Case Management Society of America, those in this profession serve as “advocates for consumer-centered care within a population health model.” Their unique skill set helps stakeholders identify the link “between social determinants and the health of the communities we provide care for.” The environment is challenging in many ways. It prompts stakeholders to focus on value-based case management: coordinated, patient-centric, and data-driven care delivery.
Determining the ROI of case management
Case managers play a critical role in better managing patients and bending the cost curve. Acting as care coordinators, case managers:
- guide the patient through his or her stay
- reduce fragmentation in care delivery
- increase the quality of services provided
Since case management efforts are often articulated in terms of cost savings, how can those cost savings be determined?
Here are 4 things to consider when determining the case management ROI:
#1: Take a closer look at length of stay (LOS)
LOS drives the cost per case. One should ask the following questions regarding case management and LOS:
- Did the case manager’s intervention and contact with post-discharge facilities allow for a timely discharge?
- Did the case manager intervene to reduce unnecessary days? If so, calculate the cost of the additional unnecessary days.
- What would the outcome have been if a case manager had not intervened?
#2: Consider reimbursement
Case managers may not directly contribute to reimbursement, but they often work with the revenue cycle team to ensure clean claims. Case management involvement in preventing medical necessity denials is extremely important to cash flow. Quality measures and discharge planning also relate back to reimbursement.
#3: Include patient outcomes
LOS could denote a positive outcome, as could high patient satisfaction scores; case managers contribute to both factors. Patient satisfaction accounts for a difference of $444 of net patient revenue (per adjusted patient day) between excellent-rated and moderate-rated hospitals.
#4: Measure quality of care
Unlike LOS, measuring quality of care can be challenging. A reduction in hospital-acquired conditions or an increase in recovery audit contractor recoupments may be two indicators. However, they are only clues as to the actual increase in the quality of care provided.
Rounding out the value: ROI of case management
The future holds much promise for case management programs in health system operations. To fully leverage the potential of expert case management resources, healthcare organizations must streamline the patient care continuum. This allows them to make the best use of staff time through outsourcing care coordination to a trusted service provider.
Growth in outsourcing case management continues, and for good reason. Strategies that bring the expertise and advantages of service providers to the table deliver returns on investment. They increase operational efficiencies to lower healthcare costs and to keep organizations at the forefront of their industry.
Discover how our case management solution can help your organization:
- track and manage your patient population
- facilitate collaboration with other providers
- decrease costs
- improve patient outcomes
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