The Evolution of Case Management: ACMA National Recap

Last week, our team traveled to Houston for the ACMA National Conference, where we joined more than 2,000 case management and transitions of care professionals for a jampacked agenda. On the heels of announcing that Allscripts Care Management is now a part of CarePort, we were excited to debut our expanded organization. Team members from CarePort and Care Management came together for three days to see our customers and make new connections.

Dr. Daniel Kraft’s opening address, which emphasized the key role technology can play in helping case management professionals meet the demands of their field, underscored just how much the field has evolved over time. Many of our Care Management team members, having joined the market during the ECIN days in the mid-90s, can speak to this personally. Many attendees also attested to this when they joined Dr. Lissy Hu’s presentation and shared some of their own history in case management. (Shout out to the person who sent her first electronic referral before the year 2000!) Lissy’s presentation explored how the role of case management has evolved as the industry continues to shift towards value-based care.  In case you missed it, here’s a brief recap of our discussion:

A Look Back

Historically, case management has been an inpatient function, focused mostly on:

  1. Utilization management
    • Identifying and designating the appropriate patient status and level of care for patients
    • Serving as a payer go-between, including communicating “pertinent clinical data to support admission, clinical condition, continued stay and authorization of post-acute services.”
    • Managing denials, appeals and the escalation process
  2. Discharge planning
    • Identifying the patient’s need for post-acute care
    • Managing the referral and placement process
  3. Compliance
    • Ensuring that case management organization is meeting CMS conditions of participation

Up until the mid-90s and early 2000s, case management was also largely paper based and case managers often felt hamstrung about providing guidance and education to patients about next-level-of-care options.

Case Management Today

Fast forward 20 years, and not only have case management processes almost completely transitioned from paper to electronic, but the purview of the case manager has been extended beyond the acute setting to the entire care continuum. These changes are reflected in the addition of two new areas of focus:

Care coordination – With increased pressure on health systems to manage patients across the continuum, care management has evolved into something that is a hybrid of traditional inpatient case management and ambulatory care coordination. Whether it’s to reduce readmissions or manage patients that are part of value-based payment programs or bundles, care management has transitioned into something that looks a lot more like care coordination.

Patient education – responsibility for patients’ post-discharge outcomes means that where they receive post-acute care is more important than ever. Now, case managers have to balance patient choice with the IMPACT Act and conditions of participation. With the right tools to make an informed choice, however, patients are more empowered and providers experience better patient outcomes.

This intersection of case management and care coordination was also the genesis behind CarePort. CarePort Guide was created as a tool to help patients make informed decisions about post-acute care without disrupting a case manager’s workflow. CarePort Connect and Insight track patients and outcomes throughout the post-acute continuum. With the addition of Care Management and Referral Management, CarePort and Allscripts are bringing innovation to discharge planning and care coordination so that no patient falls through the cracks.

We were thrilled to see our customers at ACMA last week and look forward to continuing the conversation. Want to see more? Request a demo.