Health System State of Hospital Case Management

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Over-Allocating to UR

The majority of clinical hospital-based Case Management (CM) time spent on administrative Utilization Review (UR) functions.
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Lagging Admission Reviews

Challenges with Admission Reviews being performed within 24 hours.
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Lack of Transparency

No visibility into UR workflow or productivity; technology difficult for management and staff to navigate; worklists inaccurate.
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Poor Coordination

CM not supporting physicians or nursing; poor coordination with social work and transition of care team.
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Suboptimal Continued Stay Reviews

Challenges with Continued Stay Reviews performed within 24 hours and appropriate use of criteria.
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Lack of Patient Interaction

No interaction with patient and no rapid rounds to set discharge expectation with care team.
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Poor Review Quality

Poor quality and inconsistent application of criteria and utilization of escalation protocols.
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Recruiting & Attrition Challenges

Relatively high turnover and difficulty recruiting experienced CM nurses with right attitude, attention to detail, and capability.

Health System HURC Solution

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81%

Case Management RNs spend an estimated 81% of time on utilization review work.

164

Across the 204 hospital case management FTEs in the system, this equates to 164 FTEs worth of time spent on UR work
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Note:  Additional savings through management and clerical staff  transition to model not included above.