News Feature | December 15, 2015

Care Managers Improve Patient Outcomes

Christine Kern

By Christine Kern, contributing writer

Nurses Use Information To Improve Patient Outcomes

Care navigators can play a crucial role in getting patients involved in their care.

With the recent emphasis on shifting reimbursement models from quantity to quality of services provided, healthcare organizations are searching for ways to improve patient outcomes and make their organizations more cost efficient. In today’s competitive healthcare landscape, providing a gratifying patient experience is more important than ever before. The transition of a patient between care settings becomes a focal point for hospitals to ensure the right care plan is being executed to reduce readmissions and improve the patient’s overall health, ultimately improving the hospital’s efficiency and reducing costs in terms of time and dollars.

As a Curaspan blog post notes, CMS updated the Federal Conditions of Participation (CoPs) for Discharge Planning for the first time in over a decade, and it’s a massive overhaul. One proposed change is every patient must have a discharge plan before leaving the hospital and that plan must be initiated within 24 hours of admission. Case managers and clinicians currently only provide plans for patients who meet certain criteria, and the new criteria requires a plan for every patient — including observation and same-day surgery patients — and stresses the need for collaboration and consultation with community service providers.

Care Navigators can be a crucial element in meeting this new requirement. Curaspan writes, “A Care Navigator is responsible for tracking and monitoring a patient as he or she transitions across the care continuum from acute to post-acute settings. They are tasked with making sure the right care plan is executed through continued communication with the patient, the patient, the patient’s family and providers to assist in the coordination of services.”

Care Navigators are typically licensed Registered Nurses with a background in nursing or social work, and are overseen by licensed clinicians and do not render care. Their role is to arrange care and ensure that care is received.

According to Curaspan, “Care Navigators will plan an increasingly critical role in managing the care transitions for complex patients. With proper oversight, non-clinical staff can help overburdened Case Management teams manage larger populations. The role of Care Navigators in your organization will depend on the specific population you serve and your health goals for that population.”

Care Navigators can be integral to executing comprehensive care plans. Curaspan explains, “Care Navigators are critical in facilitating longitudinal care plans and driving improved outcomes. If we think about a single patient, all of the patient’s needs have to be addressed — mental, physical and emotional. Being that comprehensive requires a plan that spans settings. It also requires buy-in from both the care team and the patient. To succeed in a value-based care system, healthcare can’t be delivered in silos. Care navigators can be the key to looking at a patient’s care in a comprehensive and collaborative manner while maintaining a strong personal relationship as he or she moves along the road to recovery.”