Re-Engineering Inpatient Case Management for Happy Physicians

HEI Case Management


In an ever-shifting landscape, healthcare organizations continue to deal with hurdles when it comes to Case Management. Factors include increasing denials, due to no-authorizations, pre-certification, TARS, levels of care and medical necessity. High length of stay often due to difficulties in managing and coordinating care logistics has led to and increasing workload and administrative tasks for physicians and staff. Care managers and staff who are dealing with a shortage in the workforce are also under  pressure to reduce denials and readmissions. A combination of these factors has resulted in  physicians and staff reporting feelings of frustration and an alarming rate of burnout. If not dealt with, these challenges can result in financial, operational, as well as cultural and engagement issues for provider organizations.

To address those issues, healthcare organizations must re-engineer value streams such as perioperative services, bed management, utilization review, discharge logistics and post-acute care. Healthcare organizations must redesign their processes to prioritize work among nurses, case managers, socials workers and discharge planners to reduce length of stay. They should create Case Management Service Centers that can offload administrative tasks, allowing case managers are to spend more time with physicians and patients.

HEI’s health systems engineers work with healthcare organizations to re-engineer Case Management to prevent out-of-network losses, reduce related denials, and implement social determinant based discharge planning to prevent readmission.

Sample deliverables of a Case Management Re-engineering include:

  • Revenue increase from improved CMI, and Case Management operations
  • 1/2 Day reduction in length of stay
  • Decrease in bed turnaround time
  • Record high engagement scores from employees
  • Creation of an effective and efficient inpatient Care Management model for the future
  • Creation of a scalable seed operation for a comprehensive patient focused support model beyond traditional silos

HEI’s Case Management Solutions includes Clinical Technology to help support the newly re-engineered processes.

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