BY, PhD, MSN, RN
CMSA’s 2021 Conference theme is “Staking a Claim in the New World.” What better way to kick off the conference than by sharing experiences and best practices from our colleagues around the globe? We know there may be differences in frameworks or processes, but our commitment to improving the health of those we serve unites us and provides an opportunity to learn and support one another regardless of place, discipline or healthcare setting.
CASE MANAGEMENT IN BRAZIL
THE BRAZILIAN HEALTH SYSTEM
Brazil is the largest country in Latin America and has two major health systems: one public, and the other private. The Unified Health System (SUS) is the largest public health system in the world and guarantees coverage for about 80% of the Brazilian population free of charge.
Created in 1988 following national health-care reform, SUS was designed on the principles of comprehensive and universal care. The organization of the system is based on Primary Care Districts, which serve families residing in each district of the city. Each Primary Care District is responsible for 2,000 people and is made up of nurses, doctors, nursing technicians, dentists and health assistants.
The private healthcare system is composed mainly of hospitals and centers for specialized care. The private system is accessed through health insurance plans and/or cash payment.
Nurses have historically helped patients navigate the Brazilian Health System, guiding access to health services and counseling patients and the community. However, these activities have always been done concurrently with activities that provide care and services to patients. Perhaps, since nurses are dedicated to both the healthcare system and case management simultaneously, this has affected the growth of case management in Brazil.
CASE MANAGEMENT IN BRAZIL: RESULTS AND CHALLENGES
In the last 3 years, the case management situation in Brazil seems to have changed. Initiatives taken from the private health system have begun to emerge, focused on reducing healthcare costs.
However, in the last semester of 2020, a new movement has been gaining momentum; the first Brazilian case management company was founded. Conceived by nurses and doctors, it is also centered on cost reduction but focuses on patient advocacy and patient engagement from the perspective of the patient’s own experience.
The context of the COVID-19 pandemic and the global economic crisis, which also impacted Brazil and threatened the budgetary sustainability of private and public health systems, has led health decision makers and policy makers to adopt and think about implementing case management initiatives.
Case management by specialized companies is focused on hospital care environments and has reported promising results, such as: reduction of hospital stays by 25%; increasing the relevance of hospital admissions from 85% to 97%; reduction of total hospitalization costs by up to 30% (MODU Case Management, 2020. General balance, Brasilia, Brasil). These results demonstrate that case management can increase the bed turnover rate and increase operational capacity.
Still in the context of the COVID-19 pandemic, the need for high-risk groups to remain socially isolated has sparked remote case management initiatives aimed at chronic patients. Using technology, managers have been remotely accompanying patients utilizing engagement and activation to keep their health conditions under control, to prevent the patient from getting worse or being readmitted, and helping them comply with care plans.
In addition, care management companies have begun working with data management and artificial intelligence. The expectation is that, in the coming years, robust algorithms with outcome prediction will be implemented to improve health outcomes, validate hospital admissions, predict case instability, identify alternatives to hospital admission, decrease clinical variability and prevent re-admissions.
Although promising, case management in Brazil is still taking its first steps, and there are still great potentials and challenges.
The first challenge is to improve the visibility of case management, to demonstrate the ability to solve complex problems that impact sustainable results. These results must go beyond cost savings; they must increase patient safety, improve their experience and stimulate higher quality among healthcare services.
In this sense, the search for cost reduction cannot be dissociated from patient advocacy. Visibility activities need to highlight the sustainability of case management in Brazil, being able to ensure: THE RIGHT CARE IN THE RIGHT PLACE AND THE RIGHT TIME.
The second challenge is knowledge. Case managers are still unknown in Brazil and need to reaffirm their role every day, and demonstrate that their activities are not in competition with other health professionals (doctors).
The third challenge is to regulate the practice of case management in Brazil, through regional and national laws. To this end, the need to create a Brazilian Society for the Management of Care (SBCM) is also highlighted, discussing whether, like other countries, other professionals may also act as case managers.