The Different Ways Case Managers Contribute to the Performance of a Hospital

Case manager talking to the doctor in chargeIn healthcare systems and hospitals, case managers play such an important part that they are slowly turning into the face of care.

Medicare case management services – a service offered by firms such as – have the responsibility to guarantee proper delivery of patient care and appropriate reimbursement to the hospital.

This is why case managers are making noteworthy contributions to enhance the performance of a hospital.

Lowering Risks of Readmission

Case managers make a massive performance difference in healthcare systems due to their strong concentration on enhancing care coordination. Based on the Commission for Case Manager Certification, they also aim to get rid of gaps in cases that lead to avoidable readmission.

For instance, Aetna physician executives revealed the way health insurers utilize case managers to enhance results for around 750 Medicare beneficiaries. They collaborated up with a physician group from Portland, Maine called NovaHealth during this study.

They published this in the September 2012 Health Affairs where the authors described 56 percent lesser readmission. They compared this to nationwide Medicare populations that were still unmanaged.

Not only that, Aetna’s Medicare members had a total per member per month charges were 16.5 percent to 33 percent lesser compared to charges for other members.

Improving Claims Management

Case managers mainly have to guarantee that every patient gets proper and apt care. They should also make sure that their admission in the hospital is delivered in the most fitting setting and is not sheltered in nature.

In the majority of hospitals, they must inform the patient regarding the decisions of their insurers about their medical requirements. They also have to guarantee that the patient gets a Hospital-Issued Notice of Non-coverage.

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Afterwards, they advocate on behalf of the patient to get the insurer to possibly change their decision.

It is high time that hospitals use the knowledge, expertise and skills of this proven workforce to improve their performance and processes.