BY LAWANNA GADDY, MSN, RN
Quality improvement and accreditation are crucial in the healthcare continuum within a rapidly changing industry landscape. Care management programs and care managers ensure that healthcare delivery is not only effective but also maintains the desired levels of quality every time. This article delves into the essential role of care management in the quality improvement and accreditation journey.
Care Management Programs: How They Benefit Patients and the Bottom Line
Care management programs are customized to provide a coordinated approach to care that meets individual needs. Through detailed evaluations and custom solutions, they enhance quality results, lower readmissions, and offer higher patient satisfaction. Care management and care coordination programs play a crucial role in reducing hospital readmissions by providing continuous support and follow-up care, ensuring that patients receive appropriate and timely interventions. Studies have demonstrated that implementing care management interventions can significantly reduce readmission rates, thereby improving patient outcomes and reducing healthcare costs (Doyle, 2018).
Effective care management is the cornerstone of superior healthcare delivery, emphasizing the importance of seamless coordination and communication among providers, patients and their families. When care is well-integrated, it prevents fragmentation and ensures a cohesive approach, minimizing the risks of duplicated services and medical errors. This integrated model fosters better health outcomes and upholds high-quality standards.
In addition, care management programs leverage data analytics to continuously monitor patient outcomes, identify emerging trends and guide informed decision-making. This data-driven approach facilitates the early detection of potential issues, enables proactive interventions and supports ongoing enhancements in the quality of care. Together, these elements highlight the critical role of care management in delivering efficient, effective and patient-centered healthcare.
Advancing Prevention of Health Conditions
Care management programs can significantly reduce the complications of chronic illness flairs by implementing comprehensive telehealth strategies. These strategies include regular screenings, vaccinations and lifestyle adjustments tailored to patient needs. The proactive approach not only improves patient care but also aligns with quality improvement and accreditation standards. A recent study highlighted that telehealth for the longitudinal management of chronic conditions effectively reduces hospital readmissions and enhances patient outcomes by ensuring continuous, tailored patient care (Lewinski et al., 2022).
Patient Advocacy, Education, and Empowerment
Care managers serve as advocates for patients to ensure they are heard and their needs are met. This advocacy is necessary to provide patient-centered care, a cornerstone of quality improvement efforts and accreditation standards. Recent research indicates that high-touch patient advocacy and care management, such as the Mobile Care Coordinator® program, significantly enhance patient engagement and outcomes, demonstrating a verified return on investment of $2 to $7 for every $1 invested (Long, 2024).
Care managers educate patients about their conditions, treatment options, and self-management strategies. By providing patients with information and resources, care managers enable them to become more engaged in managing their own care, driving better health outcomes.
Monitoring, Follow-Up, and Quality Improvement
Continuous monitoring and follow-up are essential components of effective care management programs. Care managers play a critical role by continuously engaging with patients, adjusting care plans as necessary and providing ongoing support to ensure consistent, high-quality care throughout their healthcare journey. A scoping review highlighted that strategies such as continuous patient monitoring and follow-up significantly improve care coordination, reduce hospital readmissions and enhance overall patient outcomes by fostering a comprehensive, multidisciplinary approach to care (Braz et al., 2020).
In addition to monitoring and follow-up, care managers are deeply involved in the development and implementation of quality improvement initiatives. Their unique perspectives and expertise enable them to identify areas for improvement, develop evidence-based solutions, and assess the impact of these initiatives on patient care. This dual focus on continuous patient engagement and quality improvement underscores the vital role of care managers in advancing healthcare standards and outcomes.
Accreditation: Raising the Standard and Trust
Accreditation is a yardstick for healthcare quality, indicating that care management programs meet established standards of excellence. Quality care management programs significantly influence accreditation by demonstrating adherence to best practices, showcasing successful patient outcomes and implementing continuous improvement endeavors. The rigorous accreditation process evaluates these programs for quality, efficiency and safety, enhancing their credibility and reliability. Accredited programs benefit from increased patient confidence, improved facility reputation and often enhanced reimbursement from third-party payers. The structured nature of accreditation fosters a continuous quality improvement pathway and promotes a culture of excellence throughout patient care.
According to a recent study, accreditation significantly enhances healthcare professionals’ knowledge of quality management. This increased knowledge enables staff to better implement quality improvement initiatives, leading to improved patient outcomes (Gijare, M.P., Bandyopadhyay, P.K., & Bhattacharya, S. (2021).
The “Ah-Ha” Moment of Quality Importance
My realization of the critical value of quality in care management began during my first exposure to the accreditation process. I clearly remember the day our care management program underwent its initial accreditation review. The painstaking detail and extensive regulations established by the accrediting body were daunting. This intense evaluation process validated our work and revealed many new ways to improve our care. One incident stands out: A patient with multiple chronic conditions was struggling to navigate the complex healthcare system. Our team, guided by quality improvement principles, coordinated her care seamlessly, ensuring she received timely interventions and support. Witnessing the improvement in her health and quality of life reinforced my faith in the potential of accreditation and the importance of care management programs. Quality is not an end but a continuous journey requiring diligence and an unwavering pursuit of the highest standards.
Quality doesn’t stop once accreditation is received. Now the work continues to keep your program compliant, to keep your staff up to date on best practices and to continue growing. To see lasting changes in care management programs, organizations must be committed to not just making sure the organization can become accredited, but that the care managers are consistently demonstrating and documenting member outcomes. Is the organization providing continuing education opportunities to their care managers to ensure that care managers are staying abreast of ever-evolving changes in healthcare? This part is vital! Organizations must continuously pour into their care managers to see consistent growth.
Care management programs and care managers are at the heart of quality improvement and accreditation efforts. Their dedication to patient-centered care, proactive management, and continuous improvement drives the delivery of high-quality healthcare services. Meeting rigorous accreditation standards is critical for healthcare organizations, and care management plays a crucial role in satisfying those standards, from initial accreditation to ongoing quality improvements and compliance.
References
- Gijare, M.P., Bandyopadhyay, P.K., & Bhattacharya, S. (2021). Impact of accreditation on healthcare professionals’ knowledge on quality management. International Journal of Reliable and Quality E-Healthcare, 10(3), 1-12. https://doi.org/10.4018/IJRQEH.2021070101
- Doyle, D. L. (2018). Chronic care management: Transitional care models for readmission reduction (Doctoral dissertation). Johns Hopkins University. Retrieved from ProQuest Dissertations & Theses.
- Lewinski, A. A., Walsh, C., Rushton, S., Soliman, D., Carlson, S. M., Luedke, M. W., Halpern, D. J., Crowley, M. J., Shaw, R. J., Sharpe, J. A., Alexopoulos, A.-S., Tabriz, A. A., Dietch, J. R., Uthappa, D. M., Hwang, S., Ball Ricks, K. A., Cantrell, S., Kosinski, A. S., Ear, B., Gordon, A. M., Gierisch, J. M., Williams Jr., J. W., & Goldstein, K. M. (2022). Telehealth for the longitudinal management of chronic conditions: Systematic review. Journal of Medical Internet Research, 24(8), e37100. https://doi.org/10.2196/37100
- Long, B. (2024). What is the return on investment for patient advocacy and care management? Nursing Economic$, 42(2), 102-103. https://doi.org/10.62116/NEC.2024.42.2.102
- Braz, P. G. C. G., Vila, V. S. C., & Neves, H. C. C. (2020). Strategies for case management in transitional care in emergency services: A scoping review. Revista Brasileira de Enfermagem, 73(Suppl 5), e20190506. https://doi.org/10.1590/0034-7167-2019-0506
With over 18 years of experience in healthcare, Lawanna Gaddy, MSN, RN, brings an extensive background in care management and leadership within managed care, particularly in Medicaid populations. She excels in driving quality care and ensuring healthcare excellence through her strategic vision and comprehensive knowledge. As a Registered Nurse and Certified Case Manager, Lawanna is deeply committed to empowering case managers with the tools necessary for success. Her expertise emphasizes the critical role of quality documentation in achieving healthcare accreditation and improving patient outcomes, setting the standard for excellence in care management. Passionate about the impact of effective care management, Lawanna inspires professionals to enhance both client benefits and organizational performance through robust educational and practical strategies. Her innovative approach not only drives compliance but also fosters a culture of continuous improvement and excellence in patient care. Lawanna’s dedication to advancing the field of care management makes her a leading voice and a trusted advisor in the healthcare community.
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