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The Role of Case Management in Healthcare

Alexa Cushman
November 28, 2018

Over the last several years, healthcare stands out as one of the most robustemployment sectors in the U.S. The most recent numbers from the Bureau of Labor Statistics cite 33,000 jobs created in August alone, with 301,000 added over the course of the year thus far. All told, approximately 20 million Americans hold healthcare positions as of August 2018.

Healthcare's importance to the U.S. economy and its population's well-being cannot be overstated.

Nevertheless, many leading industry groups have predicted personnel shortfalls in various segments of healthcare, particularly nursing: The American Association of Colleges of Nursing hasn't changed its projection of a nursing shortage since first issuing this warning in 2010, with the drought of registered-nurse employment expected to hold through the remaining 2010s and all the way to 2030.

Additionally, factors like the drastic uptick in America's senior-citizen population long expected by the Census Bureauwill only bolster the need for a strong and well-supported healthcare workforce. Consider, then, that all of this refers to the U.S. alone - in developing countries, such issues can be much, much worse.

Patient satisfaction and quality of care are of paramount importance to healthcare. The key to the sort of support and improvements healthcare will need lies, arguably, in proper case management - the comprehensive maintenance of patient records so they are easily accessible to all involved, including patients, their loved ones, medical professionals and insurance payers. For example, providing access to medical records between physicians so that patients can easily work with a multi-person care team. Like so many aspects of modern life, technology must play a significant role in case management's success, and tools like high-level enterprise application platforms could take position at the vanguard of this sector.

Basics of modern case management: A refresher

In the contemporary healthcare environment, case management can mean many things. The complexities of the various relationships between patients and caregivers, hospital billing departments and payers, and any other permutation thereof can throw numerouswrinkles into the process on a case-by-case basis. More often than not, they do, for a broad spectrum of different reasons: These include everything from certain people's mistrust of the health insurance industry or confusion regarding the Patient Protection and Affordable Care Act to clashes between hospitals and payers or patients' families believing that any of the aforementioned parties aren't fairly treating the ill individual.

Even a summarization of those potential problematic issues is enough to give one a feelingof whiplash, so imagine how everyone directly involved must feel.

According to the Washington, D.C.-based nonprofiteHealth Initiative, modern case management must allow for comprehensive record-keeping, facilitate internal and external accountability for care providers (e.g., monitoring patients during and after treatment) and ultimately improve patient safety. These priorities are especially critical in an era whenvalue-based care is emerging as the dominant system of operations for many providers in lieu of the longstanding but oft-criticized fee-for-service model.

Concrete personal and financial benefits

In a nutshell, when a case management system works, everybody wins. Becker's Hospital Review cited the example of a collaboration between the insurer Aetna and a Portland, Maine-based physician group named NovaHealth. By using dedicatedmanagers to handle 750 different Medicare beneficiaries, this payer-provider union reduced readmisssionsby 56 percent compared to Medicare-covered individuals in Maine who weren't receiving any specific attention of this variety.

More important than any stats like that, of course, is the human factor: When case management works as it should, individuals not only receive better overall care but feel more positively about themselves and whatever illness or injury they may have. In its way, it helps bolster hope among those who can sometimes feel hopeless.

The importance and versatility of technology

In November 2017, healthcare tech consultancy firm OPEN MINDS made case management one of the prominent topics at its Technology & Informatics Institute series of conferences. Using patient-facing software and apps as portals into their own cases, it offers them a sense of agency regarding their condition that they might not otherwise have. They can look at the same records their doctors are seeing, even when many miles apart, and point out any errors for easy correction. Also, general communication between patients and care providers is much easier with telehealth platforms and other high-tech case management tools, which can be particularly useful for less ambulatory patients or elderly individuals who wish to receive as much care as possible in the comfort of their own homes.

Appian's benefits for care providers' case management needs

Much as they have bottom lines to look after, healthcare providers and insurance payers' first priority must be patients. Without them, there'd be no bottom line. Appian's business application development platform can help bridge the gap that sometimes forms between providers or payers and the individuals they serve by providing a method by which to create both organization- and patient-facing apps that enhance the case management experience. Patients and clinicians alike can streamline their experiences in ways that help build relationships between individuals and care providers, foundations of genuine trust impossible to break once properly established. Appian is also fully HIPAA-compliant with any patient data stored on apps created using our platform.

How psHEALTHsurged forward with Appian's help

Don't simply take our word for it as described above and rely on hypotheticals. Consider the successful example of Appian client psHEALTH.

psHEALTHaimed to move patient administration systems away from the specific hospital environment and toward greater mobility and flexibility. The firm possessed the necessary know-how to develop apps to accomplish these purposes, but naturally wanted to avoiding spending a fortune and devoting countless work hours to such projects - particularly in an area like healthcare technology, which, at times, is considerably more volatile than the general healthcare field.IngolvUrnes, psHEALTHfounder and principal, elaborated on this priority:

"We don't want to code a single line," Urnesexplained. "We don't really want to spend any time on the underlying technology. We want to spend a lot of time really understanding healthcare provider processes, and we want to roll out personalized solutions in 60-90 days."

With Appianas an enthusiastic partner, Urnes and psHEALTH were able to realize that exact goal and then some. The company now offers apps for more than half a dozen different case management needs, including contract management, rostering and scheduling, rehabilitation and occupational health, disease management, outcome tracking and home care.

Check out the video below to hear Urnestell his Appian success story in his own words, and contact us to learn more about how our platform benefits healthcare case management.