Needs Assessment

• On-site assessment of the current structure of your case management department. We place great emphasis on this first phase of re-engineering. During this first step we align recommendations based on value-based purchasing and healthcare reform requirements to structure the assessment, and a document review including review of organizational characteristics, interfacing department characteristics, and assessment of the current the bottom-line value for your organization.
• We also look at your hospital routes of entry including the emergency department and the planned admission processes to ensure that your case management processes are front-loaded and hard-wired.
• Other areas reviewed include patient flow, compliance and roles and functions of the case management department including the RN case managers and the social workers.
• We also assess the relationship between the case management department and out-patient clinics, pre-implementation care processes, gaps and bottlenecks, review of monitoring, tracking and evaluation processes, and a review of case management outcome indicators.

Future State Design

• Overall, CMC's strategy is to optimally align a department to maximize case management's influence on value-based purchasing and healthcare reform.
• With that in mind, after the needs assessment and document review, CMC will prepare a comprehensive document that is tailored to each client's individual needs and issues. This includes a model design for case management on the in-patient units and the emergency department, case management role functions and job descriptions , integration of all role functions of departments, budget-neutral staffing recommendations when possible, enhanced work flow recommendations, productivity standards including performance monitoring, outcome indicators linking clinical and financial outcomes, design recommendations for the physician advisor, documentation and technology recommendations.

On-site Model Implementation Support

• We also provide implementation support. Because we know that implementing an updated model can be challenging, we offer interval on-site support during the transition.

Assessment of Case Management Areas of Compliance

• This assessment is focused on your case management department's areas of compliance including the Conditions of Participation for Utilization Review and discharge planning; the 2-Midnight Rule, the Important Message from Medicare, Choice Lists and documentation, among others.

Education

• Because education is also part of the implementation component of the model, we provide on-going support following implementation. This can be geared toward case management staff, the department of nursing, physicians or administration.
• We also provide discounts on on-site educational updates for existing clients.
• Education can also be in the form of annual updates for the staff or as a stand-alone program such as a "boot camp".

InterQual™ Education

• Our certified InterQual™ trainer is available to update your staff or educate them if InterQual™ is new to them.
• We also can provide assessments of the staff's compliance with the use of InterQual™.

On-site Director of Case Management Support

• Interim, on-site support while you are searching for a new director.
• Mentoring of an incumbent director.

Program Implementation

• Assessment and support in implementing specific programs, such as mandatory bundle payment, implementing the 2 Midnight Rule or responding to the impact of the NOTICE Act on your department.