Transcript Case Management

Case Management
In a
Primary Care Setting
Confidential: Quality
Improvement Material
Team Members
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Susan Wickey, RN
Daiva Gestautas, RN
Nancy Flynn, RN
Dr. Paul O’Keefe
Dr. Matt Fitz
Provider Relations Department
ATC Attendings, Residents and Medical Students
Confidential: Quality
Improvement Material
Background Information
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Access to Care is a public/private partnership program making primary health
care services available to those individuals who are not eligible for public
health insurance programs and or private insurance.
Loyola, Dr. Paul O’Keefe, Dr. Matt Fitz along with a team of attending
physicians, and over 15 Residents and Medical Students support a primary
care clinic.
Clinic located at an off site location.
Clinic sessions two half days per week.
Ancillary staffing no longer available to provide support services as of October
2007.
Patients have limited access to their Primary Care Physician.
Limited resources available to assist with phone calls and medication refills.
No clinical charts available as a resource for staff to access.
Medication lapses due to difficulty in contacting physicians for medication
refills.
Emergency Department accessed for non-acute illnesses.
Confidential: Quality
Improvement Material
Project Aim Statement:
To establish a Primary Care Case
Management model for the Access to Care
patients and physicians to ensure appropriate
utilization and improve quality of care while
reducing health care costs.
Magnet Forces of Magnetism –Force 7
Confidential: Quality
Improvement Material
Goals of the Primary Care
Case Management Model
• Improve access to primary
care physicians.
• Provide access to
appointment scheduling
• Provide access to clinical
staff if needed.
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Improvement Material
• Advocate for services
needed.
• Impact appropriate
utilization of services.
• To provide outreach to
patients who presented to
the ED along with follow
up and review of
discharge instructions.
Solutions Implemented:
• Physician meeting with Provider Relations to review
protocols.
• Provider Relations staff available to take calls Monday –
Friday 7:30 AM-5:00 PM.
• Nursing Triage and Intervention as needed.
• Outreach was performed to patients who presented to the
ED. Follow up appointments were scheduled and a review
of discharge instructions took place.
• Nursing Staff were available to the physicians to assist
with individual patient needs.
• Ability to overbook clinics to avoid unnecessary ED visits.
Confidential: Quality
Improvement Material
Solutions Implemented:
• Scheduling of appointments as appropriate.
• Transition to electronic medical records.
• Referrals to specialists and services were authorized based
on Milliman Care Evidenced Based Guidelines.
• Medication refills were processed with the physicians
intervention.
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Improvement Material
Tracking:
• Phone calls were logged on a
daily basis.
• Clinical staff were available to
talk with the patients and assists
with requests.
• Identification of patients who
presented to the ED.
Confidential: Quality
Improvement Material
• Medication refills to the
pharmacy were reviewed and
authorized if approved by the
PCP.
• Referral request were reviewed
and authorized according to
guidelines and PCP approval.
• Referrals to specialists and
services were authorized based
on Milliman Care Guidelines.
Phone Volume:
• Access to Care Phone
Volume
1-08 through 12-08
250
200
150
100
50
0
Jan
Confidential: Quality
Improvement Material
Mar
May
July
Sept
Nov
Measuring Success: Facility Charges
Case Management Initiated January 21, 2008
ATC Facility Charges 1/08-12/08
900,000.00
800,000.00
700,000.00
600,000.00
500,000.00
400,000.00
300,000.00
200,000.00
100,000.00
0.00
1
2
3
4
5
6
7
Month
Confidential: Quality
Improvement Material
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