How the Notion of Continuum of Care is used in Case Management within My Organization
An increasing number of people are concerned about the present healthcare system, which is heavily dependent on emergency treatment (De Regge et al., 2017). This means that patients with acute diseases often get care without the benefit of preventative measures or a developed rapport with their doctors. These developments have resulted in poor health outcomes across various patient demographics, with individuals diagnosed with chronic diseases particularly susceptible to complications and severe consequences (Southerland et al., 2020). With improved health outcomes and lower costs, the continuum of care becomes critical for both patients and caregivers. My healthcare facility uses the continuum of care approach to provide comprehensive treatment for patients needing extensive medical attention, including those most susceptible to healthcare neglect (such as the mentally ill, the elderly, and those with chronic disorders).
Case management relies on the model continuum of care to provide a trouble-free transfer from hospital to home or from home to a rehabilitation center. The psychological and social determinants of health are a particular focus of this concept’s use in case management. The possible impact of a specific diagnosis on the patient’s overall life quality may be one of these factors. Thus, the goal of case management as it pertains to the continuum care notion in my organization is to create a strategy for facilitating a patient’s seamless movement between different medical settings (De Regge et al., 2017). This is accomplished with case managers who work as champions for patients and their families throughout the healthcare process. When it comes to improving health outcomes for their clients, case managers collaborate with a wide range of parties, including direct care providers, health plans, and local communities.
New Programs at My Organization That Aid Patients in Achieving Their Health Objectives
My organization is involved in several healthcare initiatives, one of which is providing a multidisciplinary and integrated healthcare program that improves the ability of patients with respiratory needs and those most susceptible during clinical handover to communicate with various professionals and gain access to treatments. Coaching for respiratory health issues, helping to find a place to live, and other similar services fall under integrated care. With the aid of a committed interdisciplinary team, this initiative streamlines the assistance and care provided to patients. If a patient with COPD requires more intensive care, it is simple to organize referral procedures to connect them with specialists in the field. Some new services also ask consumers to choose and prioritize specific health-related outcomes. Focusing on the result can ensure that each treatment is specifically designed for the individual patient (Southerland et al., 2020). Integration of a comprehensive data-driven strategy to improve patient care, save costs, achieve operational efficiency, and increase income is another service the organization is now providing.
How these Initiatives Affect the Institution’s Bottom line
The healthcare facility has taken on the challenge of reducing the length of stay (LOS) to cut expenses and risks for our patients and the necessity to offer interdisciplinary treatment to enhance care. Care coordination and physician participation have improved, leading to a drop in LOS; more weekend discharges have occurred; 30-day readmission rates have been stabilized; and many other improvements have been made thanks to the program’s methodical, data-based approach. By enhancing the quality of one’s contacts and interactions with care providers, these approaches have helped more people take charge of their health.
The programs have increased patient transparency and information sharing, which in turn has improved patient satisfaction. Consequently, the healthcare facility has started to enjoy the financial benefits of payment models that place more emphasis on patients. For instance, the healthcare facility has saved much money thanks to measures like lowering LOS and cutting down on medicine and supplies. The increase in revenue results from happier customers, more referrals, and stronger brand name recognition.
Quality Indicators
Accessibility to quality healthcare is essential for achieving the most significant potential health outcome. Gaining admittance into health care is what we mean when discussing access. It is essential for preventing sickness and managing acute episodes and chronic conditions, so they do not worsen (Wasserman et al., 2019). We recognize a range of possibilities regarding people’s access to medical treatment. Therefore, even if treatment is accessible, its accessibility may be affected by several variables. Such factors include how simple it is to schedule an appointment with a physician, how simple it is to pay for treatment (regardless of whether or not the patient has health insurance), and how simple it is to reach and leave the facility.
In this regard, inadequate insurance makes it difficult for patients to acquire the treatment they need, and if they do, it leaves them with significant medical expenses to pay. Accessibility to hospital care, especially for people without health insurance, the underinsured, or those with just state health insurance, might be hampered by the possibility of making payments in cash (Wasserman et al., 2019). Therefore, these individuals have the highest risk of experiencing poor health outcomes due to financial obstacles to treatment.
Additionally, factors such as employment and the availability of healthcare institutions also impact the ability of patients to access quality healthcare (Wasserman et al., 2019). Regions with high unemployment rates are likely to experience poor healthcare outcomes if interventions are not established to support these individuals’ access to care.
Tying Hospital Reimbursement to Performance Indicators
Many healthcare professionals have extensively adopted pay-for-performance to improve healthcare quality. Most healthcare systems choose the fee-for-service model, which compensates providers according to the complexity of their job, the nature of their services, how long they last, and how often they are needed (Jiang et al., 2020). However, the fee-for-service model is modified by pay-for-performance, with more significant compensation for better treatment. Healthcare facilities incorporating the pay-for-performance approach receive comparatively higher reimbursements from CMS for care provided to Medicare patients. These payments target particular illnesses, including heart failure, acute myocardial infarction, coronary artery bypass graft, and pneumonitis, in addition to hip and knee replacement (Jiang et al., 2020). The sum of money the institutions receive is comparable to the quantity of Medicare funds they collect for patients treated for each specified health problem.
Grander incentives are given to hospitals that have adopted the pay-for-performance approach and have shown better performance, while facilities that perform below permissible levels are punished (Chatterjee & Werner, 2019). Monetary incentives could increase motivation to alter one’s conduct and enhance the standard of care provided to patients. In addition, hospitals and clinics that treat a disproportionate number of patients from low-income and minority backgrounds are more likely to have negative performance ratings. There is a higher risk of them being punished and a lower possibility of them obtaining incentives under the value-based compensation plan if this occurs. As a result, many doctors could avoid treating people with social risk factors to avoid financial fines.
References
Chatterjee, P., & Werner, R. M. (2019). The hospital readmission reduction program and social risk. Health services research, 54(2), 324.
De Regge, M., De Pourcq, K., Meijboom, B., Trybou, J., Mortier, E., & Eeckloo, K. (2017). The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Services Research, 17(1), 1-24.
Jiang, H., Pang, Z., & Savin, S. (2020). Performance incentives and competition in health care markets. Production and operations management, 29(5), 1145–1164.
Southerland, L. T., Lo, A. X., Biese, K., Arendts, G., Banerjee, J., Hwang, U., & Carpenter, C. R. (2020). Concepts in practice: geriatric emergency departments. Annals of emergency medicine, 75(2), 162–170.
Wasserman, J., Palmer, R. C., Gomez, M. M., Berzon, R., Ibrahim, S. A., & Ayanian, J. Z. (2019). Advancing health services research to eliminate health care disparities. American journal of public health, 109(S1), S64-S69.
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