note: this is an authorized excerpt from the achieving ... · accountable care organizations 200...

Note: This is an authorized excerpt from the Achieving High Value Healthcare. To download the entire guide, go to http://store.hin.com/product.asp?itemid=4624

or call 888-446-3530.

© 2012, Healthcare Intelligence Network — http://www.hin.com

Achieving High-Value Healthcare: Metrics

from Medical Homes, Accountable Care and

Case Management

presented by the Healthcare Intelligence Network

A publication of:The Healthcare Intelligence Network800 State Highway 71, Suite 2Sea Girt, NJ 08736Phone: (732) 449-4468Fax: (732) 449-4463http://www.hin.com

Executive Editor’s Note

Welcome to the Healthcare Intelligence Network’s Achieving High Value Healthcare: Metrics from Medical Homes, Accountable Care and Case Management.

A 2012 checklist for high-value healthcare developed by the Institute of Medicine calls for organizations to foster a culture of continuous improvement, rely on evidence-based protocols, encourage patient-clinician collaborations and employ safeguards that protect patients and reduce costly medical errors, among other recommendations.

Achieving High Value Healthcare: Metrics from Medical Homes, Accountable Care and Case Management looks at efforts by nearly 450 healthcare organizations to reshape healthcare delivery via a trio of emerging care models: the patient-centered medical home (PCMH), the accountable care organization (ACO), and case management.

9 Chapter 1: 2012 Healthcare Benchmarks: The Patient-Centered Medical Home

9 Chapter 2: 2012 Healthcare Benchmarks: Accountable Care Organizations

9 Chapter 3: 2012 Healthcare Benchmarks: Case Management

For each care model, this 180-page resource delivers an executive summary of results, year-over-year trends and sector-specific analysis of key metrics, including program components, targeted conditions and populations, supporting tools and technology and ROI.

Year-over-year comparisons in each chapter highlight innovations and interventions delivering the most bang for healthcare bucks, along with the challenges and rewards of implementation.

In the open-ended responses alone, there are more than 100 ideas to test-drive within your own organizations. We hope that trends and benchmarks presented in this resource will inspire payors and providers to strive for a value-based healthcare delivery system grounded in quality and efficiency.

Melanie Matthews, HIN executive vice president and chief operating officer

2012 Healthcare Benchmarks: The Patient-Centered Medical Home 95 healthcare organizations discuss the latest metrics and measures on current and planned PCMH initiatives, as well as PCMH effectiveness, targeted populations and conditions, medical home team members, health IT in use and more.

“[The biggest challenge we faced in medical home creation] was educating the patients as to the meaning of a medical home, as well as getting participation and buy-in.”> Community health center

“The diabetes and COPD populations [are our targeted individuals for our planned medical home].”> Healthcare consulting company

“[The most effective tool in use in our medical home] is a patient profile, which includes all providers, specific care gaps, etc.”> Care coordination organization

“In the year to come, healthcare reform will strengthen the medical home by providing new revenue sources that support the care of more patients in innovative ways.”> Hospital/health system

© 2012, Healthcare Intelligence Network — http://www.hin.com 2

Chapter 1 Table of Contents

About the Healthcare Intelligence Network ...................................................7Executive Summary .......................................................................................7

Survey Highlights .......................................................................................... 8Key Findings ................................................................................................. 8

Program Components .................................................................................. 8Results, Reimbursement and ROI from PCMHs ........................................... 9Predicted Effects of Healthcare Reform on the Medical Home ................... 9

Methodology ................................................................................................ 9Respondent Demographics ..........................................................................10Using This Report ........................................................................................10Responses by Sector .....................................................................................11

The Hospital Perspective .............................................................................14The Health Plan Perspective ........................................................................ 15

Year-Over-Year Survey Data ......................................................................... 16Respondents in Their Own Words ............................................................... 18

Medical Home Creation Challenges ........................................................... 18Most Effective Tool, Workflow or Process ................................................... 19Healthcare Reform’s Effect on Medical Home Programs ........................... 20Target Populations of Future Medical Homes ............................................ 20Additional Comments .................................................................................. 21

Conclusion ...................................................................................................22Responses to Questions ..............................................................................22

Figure 1: All - Establishing Medical Homes ................................................. 23Figure 2: All - Percentage of Patients with Designated Medical Home ...... 23Figure 3: All - Targeted Populations ........................................................... 24Figure 4: All - Targeted Conditions ............................................................. 24Figure 5: All - Lives Covered by the Medical Home .................................... 25Figure 6: All - Number of Participating Physicians ..................................... 25Figure 7: All - Time to Convert to a Medical Home .................................... 26Figure 8: All - Technology Used in the Medical Home ............................... 26Figure 9: All - Education and Engagement Patient Strategies .....................27Figure 10: All - PCMH Team Members .........................................................27Figure 11: All - Case Manager Embedded in PCMH .................................... 28Figure 12: All - PCMH Effect ........................................................................ 28Figure 13: All - PCMH Impact ...................................................................... 29Figure 14: All - Medical Homes in ACOs ..................................................... 29Figure 15: All - Reimbursement Model ....................................................... 30Figure 16: All - Incentives for PCMH Participation ...................................... 30


Figure 17: All - Measuring PCMH Effectiveness ........................................... 31Figure 18: All - Program ROI ........................................................................ 31Figure 19: All - PCMH Accreditation/Recognition ....................................... 32Figure 20: All - Future Medical Homes ...................................................... 32Figure 21: All - Barriers to PCMH Adoption ................................................ 33Figure 22: All - Organization Type .............................................................. 33Figure 23: Hospital - Established Medical Homes ...................................... 34Figure 24: Hospital - Percentage with Designated Medical Home ............. 34Figure 25: Hospital - Targeted Populations ................................................ 35Figure 26: Hospital - Targeted Conditions .................................................. 35Figure 27: Hospital - Lives Covered by Medical Home ............................... 36Figure 28: Hospital - Number of Participating Physicians .......................... 36Figure 29: Hospital - Time to Convert to a Medical Home..........................37Figure 30: Hospital - Technology Used in the Medical Home .....................37Figure 31: Hospital - Education and Engagement Patient Strategies .............. Figure 32: Hospital - PCMH Team Members .............................................. 38Figure 33: Hospital - Case Manager Embedded in PCMH .......................... 39Figure 34: Hospital - PCMH Effect .............................................................. 39Figure 35: Hospital - PCMH Impact ............................................................ 40Figure 36: Hospital - Medical Homes in ACOs ............................................40Figure 37: Hospital - Reimbursement Model...............................................41Figure 38: Hospital - Incentives for PCMH Participation .............................41Figure 39: Hospital - Measuring PCMH Effectiveness ................................ 42Figure 40: Hospital - Program ROI ............................................................. 42Figure 41: Hospital - PCMH Accreditation/Recognition .............................. 43Figure 42: Hospital - Future Medical Homes.............................................. 43Figure 43: Health Plans - Established Medical Homes ............................... 44Figure 44: Health Plans - Percentage with Designated Medical Homes .... 44Figure 45: Health Plans - Targeted Populations ......................................... 45Figure 46: Health Plans - Targeted Conditions ........................................... 45Figure 47: Health Plans - Lives Covered by Medical Home ........................ 46Figure 48: Health Plans - Number of Participating Physicians ................... 46Figure 49: Health Plans - Time to Convert to a Medical Home ................. 47Figure 50: Health Plans - Technology Used in the Medical Home ............. 47Figure 51: Health Plans - Education and Engagement Patient Strategies ... 48Figure 52: Health Plans - PCMH Team Members ....................................... 48Figure 53: Health Plans - Case Manager Embedded in PCMH ................... 49Figure 54: Health Plans - PCMH Effect ....................................................... 49Figure 55: Health Plans - PCMH Impact ..................................................... 50Figure 56: Health Plans - Medical Homes in ACOs ..................................... 50Figure 57: Health Plans - Reimbursement Model ........................................ 51Figure 58: Health Plans - Incentives for PCMH Participation ...................... 51


Figure 59: Health Plan - Measuring PCMH Effectiveness ........................... 52Figure 60: Health Plan - Program ROI ........................................................ 52Figure 61: Health Plans - PCMH Accreditation/Recognition ........................53Figure 62: Health Plans - Future Medical Homes ........................................53

Appendix A: 2012 Patient-Centered Medical Homes Survey Tool ...................55About the Contributor ................................................................................ 60


In 2012, 52% of survey respondents

have established medical homes for their population.

“Our biggest challenge in medical

home creation was informing

the employees of the benefits, and

collaborating with the health coaches.”

About the Healthcare Intelligence Network

The Healthcare Intelligence Network (HIN) is an electronic publishing company providing high-quality information on the business of healthcare. In one place, healthcare executives can receive exclusive, customized up-to-the-minute information in five key areas: the healthcare and managed care industry, hospital and health system management, health law and regulation, behavioral healthcare and long-term care.

Executive Summary

The rise in medical home starts over the last six years has been accompanied by a steady climb in patient satisfaction. This metric has risen from 49 percent in 2006 to 79 percent in 2009 to 86 percent in 2012, according to 95 healthcare companies who completed the sixth annual Healthcare Intelligence Network survey on Patient-Centered Medical Homes (PCMH).

When asked in 2006, only 33 percent of respondents were trying to establish a medical home. However, by 2012, 52 percent have established medical homes for their populations. And 59 percent of existing medical homes are now or soon will be part of an accountable care organization (ACO).

With increased patient accountability in the PCMH, ACOs and other emerging healthcare delivery models, healthcare organizations need to engage patients in ways that increase quality, reduce cost and improve their overall healthcare experience. The top three reported ways to educate and engage patients in the medical home are physician training (79 percent), health coaching (76 percent) and patient outreach (66 percent).

Medical home occupancy is on the rise, too. The majority of respondents in 2006 and 2009 reported that only 0 to 5 percent of their members/patients were assigned a designated medical home, but in 2012 the highest percentage of respondents (28 percent) said participation was at 21 percent or more.

Time for medical home conversion has dropped for most, from 12-18 months in 2009 to less than a year in 2012.

Electronic health records (EHRs) remained the top health IT used from 2009 (74 percent) to 2012 (90 percent). Other top tools in 2012 are e-prescribing, patient registries and e-mail or text message.



15.4%

15.4%

7.7%46.2%

7.7%

7.7% Physician-led care (0.0%)

Whole person approach

Care coordination (0.0%)

Quality improvement

Patient safety (0.0%)

Enhanced access (0.0%)

Technology

Reimbursement

Staff buy-in

Certification/recognition (0.0%)

Health literacy (0.0%)

Other

1.9%

14.8%

20.4%

7.4%7.4%

3.7%

14.8%

29.6%

Behavioral health

Disease management (0.0%)

Health plan

Hospital/health system

Community health center

Primary care provider

Specialist care provider

Multi-specialty physician group

Other

Figure 21: All - Barriers to PCMH Adoption

© 2012

Figure 22: All - Organization Type

© 2012

What has been the biggest barrier to PCMH adoption by your organization?

Which of the following best describes your organization type?

HIN Patient-Centered Medical Homes Survey May, 2012

HIN Patient-Centered Medical Homes Survey May, 2012

2012 Healthcare Benchmarks: Accountable Care Organizations 200 healthcare organizations discuss new activity in accountable care organizations, ACO reimbursement models, and the impact and early successes of accountable care.

“[The greatest success achieved to date in our ACO] is improvement in clinical and financial integration.”> Hospital/health system

“Information and data to be used to drive strategy is our [most effective tool is use in our ACO].”> Care management and technology company

“[Our greatest success achieved in our ACO] is the alignment of incentives.” > Health plan

“Case management and care stratification tools are the [most effective tools in our ACO].”> Hospital/health system


2012 Healthcare Benchmarks: Accountable Care

Organizations The second annual edition of this special report is based on results from Healthcare Intelligence Network’s “Accountable Care Organizations in 2012” e-survey administered in May 2012.

Contributing SpeakerBruce Nash, MD, MBA, senior VP of medical affairs and CMO for Capital District Physicians’ Health Plan Inc. (CDPHP)

Executive EditorMelanie MatthewsHIN executive vice president and chief operating officer

Project EditorsPatricia DonovanJessica Papay

Document DesignJane Salmon





Program Components .................................................................................. 8Results, Reimbursement and ROI from ACOs .............................................. 8Some Early ACO Successes ........................................................................... 9Some Effective ACO Tools, Workflows or Protocols ........................................9

Methodology ................................................................................................ 9Respondent Demographics ........................................................................... 9Using This Report ........................................................................................10Analysis of Responses ..................................................................................11

Highlights from Survey Results .....................................................................11Responses by Sector .................................................................................... 12

The Hospital/Health System Perspective .................................................... 16The Health Plan Perspective ........................................................................ 16

Respondents in Their Own Words ............................................................... 21Greatest Success Achieved to Date ............................................................ 21Most Effective Tool, Workflow or Protocol ................................................ 22Additional Comments ................................................................................. 22

Conclusion ...................................................................................................23Responses to Questions ..............................................................................23

Figure 1: All - Participating in an ACO ......................................................... 24Figure 2: All - ACO Administration .............................................................. 24Figure 3: All - Number of Participating Physicians ..................................... 25Figure 4: All - Healthcare Providers in ACO ................................................ 25Figure 5: All - Supporting Healthcare Professionals ................................... 26Figure 6: All - Participating in CMS’s Shared Savings ................................. 26Figure 7: All - Participating Populations ......................................................27Figure 8: All - Lives Covered by ACO ...........................................................27Figure 9: All - Time Required for ACO Creation .......................................... 28Figure 10: All - EHR Use in the ACO ............................................................ 28Figure 11: All - ACO Reimbursement Model................................................ 29Figure 12: All - Metrics to Measure ACO Success ....................................... 29Figure 13: All - Quality Measure Sets in Use ............................................... 30Figure 14: All - Program ROI ....................................................................... 30Figure 15: All - Program Impact ................................................................... 31Figure 16: All - Biggest Challenge in ACO Creation ...................................... 31


Figure 17: All - Plan to Launch ACO ............................................................ 32Figure 18: All - Future ACO Administration ................................................ 32Figure 19: All - Future Number of Participating Physicians ........................ 33Figure 20: All - Biggest Barrier to ACO Creation ........................................ 33Figure 21: All - ACO Survival of U.S. Supreme Court Challenge .................. 34Figure 22: All - Organization Type .............................................................. 34Figure 23: All - Region Location .................................................................. 35Figure 24: Hospital - Participating in an ACO ............................................. 35Figure 25: Hospital - ACO Administration ................................................... 36Figure 26: Hospital - Number of Participating Physicians .......................... 36Figure 27: Hospital - Healthcare Providers in ACO ......................................37Figure 28: Hospital - Supporting Healthcare Professionals .........................37Figure 29: Hospital - Participating in CMS’s Shared Savings ...................... 38Figure 30: Hospital - Participating Populations .......................................... 38Figure 31: Hospital - Lives Covered by ACO ................................................ 39Figure 32: Hospital - Time Required for ACO Creation ............................... 39Figure 33: Hospital - EHR Use in the ACO ..................................................40Figure 34: Hospital - ACO Reimbursement Model .....................................40Figure 35: Hospital - Metrics to Measure ACO Success ..............................41Figure 36: Hospital - Quality Measure Sets in Use ......................................41Figure 37: Hospital - Program ROI .............................................................. 42Figure 38: Hospital - Program Impact ........................................................ 42Figure 39: Hospital - Biggest Challenge in ACO Creation ........................... 43Figure 40: Hospital - Plan to Launch ACO .................................................. 43Figure 41: Hospital - Future ACO Administration ....................................... 44Figure 42: Hospital - Future Number of Participating Physicians .............. 44Figure 43: Hospital - Biggest Barrier to ACO Creation ............................... 45Figure 44: Hospital - ACO Survival of U.S. Supreme Court Challenge ........ 45Figure 45: Hospital - Region Location......................................................... 46Figure 46: Health Plans - Participating in an ACO ...................................... 46Figure 47: Health Plans - ACO Administration ........................................... 47Figure 48: Health Plans - Number of Participating Physicians ................... 47Figure 49: Health Plans - Healthcare Providers in ACO .............................. 48Figure 50: Health Plans - Supporting Healthcare Professionals ................. 48Figure 51: Health Plans - Participating in CMS’s Shared Savings ................ 49Figure 52: Health Plans - Participating Populations ................................... 49Figure 53: Health Plans - Lives Covered by ACO ......................................... 50Figure 54: Health Plans - Time Required for ACO Creation ........................ 50Figure 55: Health Plans - EHR Use in the ACO ............................................. 51Figure 56: Health Plans - ACO Reimbursement Model ............................... 51Figure 57: Health Plans - Metrics to Measure ACO Success ....................... 52Figure 58: Health Plans - Quality Measure Sets in Use .............................. 52


Figure 59: Health Plans - Program ROI ........................................................53Figure 60: Health Plans - Program Impact ..................................................53Figure 61: Health Plan - Biggest Challenge in ACO Creation ...................... 54Figure 62: Health Plan - Plan to Launch ACO ............................................. 54Figure 63: Health Plans - Biggest Barrier to ACO Creation ..........................55Figure 64: Health Plans - ACO Survival of U.S. Supreme Court Challenge ..55Figure 65: Health Plans - Region Location .................................................. 56

Appendix A: 2012 Accountable Care Organizations Survey Tool ............................. 59

About the Speaker ..................................................................................... 64


Physicians administer 24% of respondent ACOs.

“Physician understanding and

engagement are the greatest successes achieved to date in

our ACO.”



Executive Summary

Participation in accountable care initiatives has more than doubled in the last 12 months, according to 200 healthcare companies who completed the second annual Healthcare Intelligence Network survey on Accountable Care Organizations (ACOs).

Almost a third of this year’s respondents — 31 percent — participate in an ACO, up from 14 percent of respondents in 2011. And two-thirds of respondents say ACOs will survive even if the U.S. Supreme Court strikes down healthcare reform legislation, a decision that is expected as early as this month.

The last 12 months have been a hotbed of ACO activity. Announcements of accountable care collaboratives and partnerships have been frequent, and CMS kicked off its Medicare Shared Savings Program (an ACO for Medicare beneficiaries) on April 1. Just over half of this year’s respondents are participating in the CMS Shared Savings program.

The number of ACOs with a hospital at the helm has dropped dramatically, from 32 percent in 2011 to around 5 percent. The survey found physician-led ACOs to be the most common, with a quarter of 2012 respondents indicating that physicians are administering their ACO.

The typical ACO is smaller, too, as the number of active ACOs with 100 to 500 physicians dropped almost 50 percent in the last 12 months. Twenty-seven percent of this year’s respondents report ACOs of that size, versus almost half of last year’s respondents.

This year’s survey provided new data on other healthcare professionals in the ACO, ACO reimbursement models, and ACO impact. Respondents said care coordination has improved as a result of ACO activity, and hospital readmissions for patients in ACOs has declined.



54.1%

75.7%

21.6%

5.4%

0.0%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Commercial Medicare Medicaid Uninsured Other

10.8%

13.5%

24.3%

48.6%

2.7%

1 to 1,999

2,000 to 4,999

5,000 to 9,999

10,000 or more

Other

Figure 7: All - Participating Populations

HIN Accountable Care Organizations Survey May, 2012© 2012

Figure 8: All - Lives Covered by ACO

© 2012

HIN Healthcare Case Management Survey January, 2012

Which population(s) participate in the ACO?

How many lives are covered by the ACO?

2012 Healthcare Benchmarks: Case Management 153 healthcare organizations discuss efforts and contributions of case management across the care continuum.

“Getting physicians to utilize case management is our [greatest challenge of embedding or co-locating a case manager at a care site].”> Hospital

“[The greatest benefit of embedding or co-locating a case manager at a care site] is having the individual available for face to face encounters with patients and physicians.”> Physician organization

“Transitional care from hospital to home has had the [most significant impact on the population served by case managers].” > Other healthcare provider

“[The most important contribution of the case manager to our organization] is a reduction in readmissions.”> Managed Care Organization


2012 Healthcare Benchmarks:

Case Management This special report is based on results from Healthcare Intelligence Network’s “Healthcare Case Management in 2012” e-survey administered in February 2012.

Executive EditorMelanie MatthewsHIN executive vice president and chief operating officer

Contributing SpeakerJay HaleDirector of quality improvement and clinical operations, Carolina Behavioral Health Alliance

Project EditorsPatricia DonovanJessica Papay

Document DesignJane Salmon





Program Components .................................................................................. 8Results and ROI from Healthcare Case Management Programs .................. 8Some Effective Case Management Tools, Workflow and Protocols ............. 9

Methodology ................................................................................................ 9Respondent Demographics ........................................................................... 9Using This Report ........................................................................................10Analysis of Responses ..................................................................................11

Highlights from Survey Results .....................................................................11Responsibilities, Case Loads and ROI .......................................................... 12Successful Case Management Interventions and Benefits ......................... 12

Responses by Sector .................................................................................... 15The MCO Perspective .................................................................................. 19The Health Plan Perspective ........................................................................ 19The Hospital Perspective ............................................................................ 20

Year-Over-Year Survey Data ......................................................................... 21Respondents in Their Own Words ...............................................................26

Most Impactful Tool, Protocol, Workflow or Intervention ........................ 26Key to Successful Case Management ......................................................... 26Contribution of the Case Manager ............................................................. 28

Conclusion .................................................................................................. 30Responses to Questions ............................................................................. 30

Figure 1: All - Have Case Management Program ......................................... 31Figure 2: All - Plan to Add Case Management Program .............................. 31Figure 3: All - Targeted Populations for Case Management ....................... 32Figure 4: All - Targeted Conditions for Case Management ........................ 32Figure 5: All - Case Management Impact on Diagnoses ............................. 33Figure 6: All - Identifying Individuals for Case Management ..................... 33Figure 7: All - Embedded or Colocated Case Managers ............................. 34Figure 8: All - Case Manager Work Locations ............................................ 34Figure 9: All - Case Manager Duties ........................................................... 35Figure 10: All - Most Important CM Responsibilities .................................. 35Figure 11: All - Case Management Caseload ............................................... 36Figure 12: All - Interaction Methods with Patients ..................................... 36Figure 13: All - Case Manager Education Level ............................................37


Figure 14: All - Required Certifications ........................................................37Figure 15: All - Case Manager Performance Evaluation .............................. 38Figure 16: All - Program Impacts ................................................................ 38Figure 17: All - Case Management ROI ....................................................... 39Figure 18: All - Organization Type ............................................................... 39Figure 19: MCO - Have Case Management Program ..................................40Figure 20: MCO - Plan to Add Case Management Program .......................40Figure 21: MCO - Targeted Populations for Case Management ..................41Figure 22: MCO - Targeted Conditions for Case Management ....................41Figure 23: MCO - Case Management Impact on Diagnoses ....................... 42Figure 24: MCO - Identifying Individuals for Case Management ............... 42Figure 25: MCO - Embedded or Colocated Case Manager ......................... 43Figure 26: MCO - Case Manager Work Locations ....................................... 43Figure 27: MCO - Case Manager Duties ..................................................... 44Figure 28: MCO - Most Important CM Responsibilities ............................. 44Figure 29: MCO - Case Management Caseload .......................................... 45Figure 30: MCO - Interaction Methods with Patients ................................ 45Figure 31: MCO - Case Manager Education Level ....................................... 46Figure 32: MCO - Required Certifications ................................................... 46Figure 33: MCO - Case Manager Performance Evaluation ......................... 47Figure 34: MCO - Program Impacts ............................................................ 47Figure 35: MCO - Case Management ROI ................................................... 48Figure 36: Health Plan - Have Case Management Program ....................... 48Figure 37: Health Plans - Plan to Add Case Management Program ........... 49Figure 38: Health Plans - Targeted Populations for Case Management ..... 49Figure 39: Health Plans - Targeted Conditions for Case Management ...... 50Figure 40: Health Plans - Case Management Impact on Diagnoses .......... 50Figure 41: Health Plans - Identifying Individuals for Case Management ..... 51Figure 42: Health Plans - Embedded or Colocated Case Managers ............ 51Figure 43: Health Plans - Case Manager Work Locations .......................... 52Figure 44: Health Plans - Case Manager Duties ......................................... 52Figure 45: Health Plans - Most Important CM Responsibilities ..................53Figure 46: Health Plans - Case Management Caseload ...............................53Figure 47: Health Plans - Interaction Methods with Patients ................... 54Figure 48: Health Plans - Case Manager Education Level .......................... 54Figure 49: Health Plans - Required Certification .........................................55Figure 50: Health Plans - Case Manager Performance Evaluation ..............55Figure 51: Health Plans - Program Impacts ................................................. 56Figure 52: Health Plans - Case Management ROI ....................................... 56Figure 53: Hospital - Have Case Management Program ..............................57Figure 54: Hospital - Plan to Add Case Management Program ...................57Figure 55: Hospital - Targeted Populations for Case Management ............ 58


Figure 56: Hospital - Targeted Conditions for Case Management ............. 58Figure 57: Hospital - Case Management Impact on Diagnoses .................. 59Figure 58: Hospital - Identifying Individuals for Case Management .......... 59Figure 59: Hospital - Embedded or Colocated Case Managers ..................60Figure 60: Hospital - Case Manager Work Locations .................................60Figure 61: Hospital - Case Manager Duties..................................................61Figure 62: Hospital - Most Important CM Responsibilities .........................61Figure 63: Hospital - Case Management Caseload ..................................... 62Figure 64: Hospital - Interaction Methods with Patients ........................... 62Figure 65: Hospital - Case Manager Education Level ................................. 63Figure 66: Hospital - Required Certification ............................................... 63Figure 67: Hospital - Case Manager Performance Evaluation .................... 64Figure 68: Hospital - Program Impacts ....................................................... 64Figure 69: Hospital - Case Management ROI ............................................. 65

Appendix A: 2012 Healthcare Case Management Survey Tool ..................... 69About the Speaker ......................................................................................74


90% of survey respondents utilize case managers in their oganization.

“Having nurses with a broad experience

base, strong interpersonal skills and strong critical thinking skills is an

important factor of a successful

case management program.”



Executive Summary

To adequately prepare for 2012 and beyond, healthcare companies are utilizing case managers in greater numbers to help identify and manage high-cost, high risk patients. Whether in the health plan office or out at a care site, case managers are having a positive impact on service utilization, management of chronic illness and healthcare spend.

The third annual Healthcare Case Management e-survey conducted in February 2012 by the Healthcare Intelligence Network sought to once again document the efforts and contributions of case management across the care continuum. This year’s survey probed for specifics in three new areas: trends in embedded case management, including work locations of co-located case managers and the greatest challenges and benefits of embedding case manager at the point of care; clinical conditions targeted by case managers, and preferred case management certifications.

Responses provided by 153 healthcare organizations indicate that while the level of case management activity remained constant from 2010 to 2012, half of responding organizations are installing case managers at care sites. There was a dramatic rise in the embedding of case managers at primary care offices — a practice that quadrupled over the last 12 months.

Survey Highlights

9 Four times as many case managers are co-located in primary care in 2012 as they were last year —58 percent this year versus 14 percent in 2011.

9 In response to new queries on the clinical conditions of most importance to case management programs, 66 percent said individuals with diabetes are the patients most frequently targeted by case management interventions. Their efforts are rewarded: diabetes is also the condition that responds best to case management outreach, say 29 percent.



3.3%

50.5%

73.6%

4.4% 4.4%9.9%

19.8%5.5%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%

64.1%

6.3%10.9%

35.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

CCM Certified CaseManagement

CMC CaseManagement-Certified

ACM Accredited CaseManager

Other

Figure 13: All - Case Manager Education Level

HIN Healthcare Case Management Survey January, 2012© 2012

Figure 14: All - Required Certifications

© 2012

HIN Healthcare Case Management Survey January, 2012

What is the preferred education level of a case manager?

What additional certifications are required of a case manager?

note: this is an authorized excerpt from the achieving ... · accountable care organizations 200...

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