Blueprints for Transformation

 PHOENIX Medical Management, IncSolutions for hospital care management program assessments, transformational redesign, education, training, and interim leadership.

 

BLUEPRINTS FOR TRANSFORMATION: 

Moving from Case Management to Care Coordination©

                

Program Description

The healthcare marketplace is undergoing seismic changes and despite the uncertainties of the political landscape, healthcare organizations across the county are diving into initiatives that will help them succeed under emerging models.

In this new environment, case managers are quickly becoming essential players as hospital execs and case management program leaders recognize that business as usual won’t support tomorrow’s value proposition. The future requires care coordination for selected, high-risk patient populations in the hospital and across the continuum to improve patient care outcomes, increase efficiency, and reduce the costs of care. Care coordination as an enterprise-wide core competency will engage consumers, promote continuity, and create opportunities to grow and thrive.    

Join us for this one-day program which highlights the current marketplace, the disruptions in care delivery and payment models, and the innovative impact on traditional hospital case management programs.  The essential components of NexGen, value-based hospital case management programs will be explored and we will briefly tackle the changing landscape of utilization review and the role of the Utilization Review Committee.  

Who Should Attend

This course was developed at the request of hospital executives to provide a broad overview of the value based environment and the transition from traditional case management departments to care coordination programs across the enterprise.  It is perfect for leadership and front-line staff directly or indirectly responsible for any aspect of the patients’ progression-of-care through the continuum.  This includes ED leadership team, social service personnel, utilization review specialists, ACO leaders, nurse managers, revenue cycle representatives, hospitalists, care/case managers, admissions and bed management personnel, quality/performance improvement professionals, physician advisors, contract coordinators, the C-suite team and Board representatives. Program content is applicable to large academic teaching facilities, community hospitals, LTACHs, rehab facilities, and Critical Access Hospitals.

Faculty (Subject to Change)

Stefani Daniels, MSNA, RN, ACM, CMAC spent her career in the executive suite of hospitals and is the Founder and Managing Partner of Phoenix: The Hospital Case Management Company.  She is the co-author of The Hospital Guide to Contemporary Utilization Review 1st & 2nd editions, and the popular text The Leader’s Guide to Hospital Case Management.  She is a contributing author to the 2nd & 3rd editions of CMSA’s Core Curriculum for Case Managers and serves on the editorial boards of Lippincott’s Professional Case Manager and HCPro’s Case Management Monthly.  Stefani is a panel member of several web discussion groups including The Appeal Academy’s Finally Friday and RAC Monitor’s Talk Tuesday and is a popular speaker on contemporary hospital-based case management.

Objectives

  1. Explain the impact that the transition from volume to value has had on the hospital industry.
  2. Identify alternative models of hospital case management programs and discuss the advantages/challenges among alternative practice models.
  3. Discuss the transformation from case manager to care coordinator.
  4. Examine the difference between utilization review and resource management.
  5. Describe the difference between process outcomes and Patient Reported Outcome Measures (PROM).

Time

Topic

8:00 -- 8:10

Welcome, Objectives

8:10 – 8:30

What is Hospital Case Management (HCM)

8:30 -- 10:00

The Market Place

10:00 – 10:15

Break

10:15 –11:00

Payment Methodologies, Penalties and rewards

11:00– 11:30

The Reform Landscape – Care delivery and payment alternatives

11:30 –12:00

Compliance

12:00 -- 12:45

Lunch

12:45 –1:45

Preparing for Value-Based HCM – Culture, Vision, & Structure

1:45 – 2:45

Workflow and Operations

2:45 – 3:00

Break

3:00 – 3:30

Medical Necessity & Utilization Review

3:30 – 4:00

Regulations, Payer Contracts and Denial Prevention

4:00 – 4:15

Outcomes

4:15 – 4:30

Wrap up and Questions and Answers

When
7/19/2019
 

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