BY PATRICIA RESNIK, MJ, MBA, FACHE, RRT, CPHQ, CHC, CHPC
Quality, case management (CM) and utilization management (UM) are key to the financial success of a healthcare organization and play a vital role in the revenue cycle. This article focuses on important connections between quality, CM and UM, and the potential impact on organizational financial outcomes.
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.
BY VIVIAN GREENWAY, PhD, MSA, BSN, RN, PAHM, CCM, & SAJINI PAUL, MSN, RN
When defining quality management, one can think of it as overseeing all activities and tasks that must be done to support a desired level of excellence. This includes the determination of quality policies, creating and implementing quality planning and assurance, in addition to quality control and quality improvement.
BY TIFFANY FERGUSON, LMSW, CMAC, ACM, AND GARRY CARNEAL, JD, MA
In the realm of case management, where the efficient assessment and coordination of care for high-risk and complex patients are paramount, the desire for improved technology efficiency has emerged as a solution to promote better clinical and business outcomes. This includes implementing more effective population health interventions without increasing the number of staff.
BY JANET COULTER, MSN, MS, RN, CCM, FCM
Case managers play a vital role in serving the diverse populations we engage with. Despite the ever-changing landscape and challenges in healthcare, our focus remains centered on the patient. We place patients at the heart of everything we do.
BY DR. COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM
Several years ago, while in my DNP population health class, I had a “discussion” with my instructor regarding the intersection of population health and the practice of professional case management.
BY SAMANTHA WALKER, RN, DNP, CCM, AND SANDRA ZAWALSKI, MSN, RN, CRRN, CCM, ABDA, MSCC
This story is based on true events; only the names have been changed to protect identities. Therefore, we will call the patient Stella and, as luck would have it, Stella was also a certified case manager.
BY TIFFANY FERGUSON, LMSW, CMAC, ACM, AND JENNY QUIGLEY-STICKNEY, MSN, RN, MHA, MA, CCM, ACM-RN, CMAC, CPHM
The COVID-19 Public Health Emergency (PHE), which is nationally coming to a close in May 2023, transformed our healthcare system across the continuum of care changing rules and regulations to speed the throughput and facilitate safe transitions of care by imploding the current healthcare structure.
BY DR. COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM
The practice of case management and the organizations that support the work of CMs is enormously varied. To begin with, CMs come from and practice in every area within the healthcare continuum of care.
BY JENNY QUIGLEY-STICKNEY, RN, MSN, MHA, MA, CCM, ACM-RN, CPHM, CMAC
CMS 1135 pandemic waivers give healthcare providers throughout the COVID pandemic the ability to relax legal standards for Conditions of Participation and transitions of care. Allowing the healthcare industry flexibility with current CMS Conditions of Participation rules for managing transitions of care has increased fluidity and speed of transition for patient care.