A Veteran Case Manager’s Guide to Sustaining Quality Outcomes

By Marianne Ostrogorski | October 18, 2017

In the last five years, there’s been a surge in actively employed certified case managers. The Commission for Case Manager Certification records show the increase is from 20,000 to 37,000 in just half a decade. The Case Management Society of America shared with Medline that 95 percent are registered nurses, like Alex Trespeces, a case manager with a Fortune 50 company. Trespeces has more than 20 years of homecare experience as a registered nurse with a hospital background, and the transition to case management was a natural progression with his experience. Trespeces also worked for 12 years in a Medicaid home health aide company, dealing with Managed Care Organizations to obtain services for patients. Trespeces talked with Medline about the challenges case managers deal with on a daily basis, and tips for newer case managers in this growing field.

What’s a typical day like for you and how do you keep everything organized?

Like most professionals, my day technically gets started around 8:00 a.m. However, the work really begins well before that. The moment I wake up, I get right to my computer to check my email and work through cases electronically. Mid-day I head out to see one or two members. It may not seem like a lot, but there’s usually a lot of traveling, heading to different counties to check on the members.

What advantage does a nurse have in becoming a case manager?

First, I was already dealing with Medicaid during my time in home care. Second, traveling nurses have another advantage because that’s what a case manager’s job often requires, a lot of travelling. Finally, nurses can utilize the Personal Care Assistant Nursing Assessment Tool. This tool is designed to gain an understanding of a member’s limitations, their activities of daily living (ADL), as well as providing a face-face assessment that can only be performed by a nurse. This tool totals up how many hours a member can get.

With your experience you’ve seen some significant changes in case management. What modifications are having the biggest impact on a case manager’s responsibilities?

It’s much stricter with billing for Medicare and Medicaid. These entities like to bill as soon as possible because everything has moved to electronic recording. It’s very important these members and patients get seen right away. Back in the 1980s it was all paperwork. While it’s much more efficient and clear now with the data, it puts the pressure on a case manager to respond ASAP, otherwise face non-compliance.

Most case managers have no less than 60 to 120 cases a month assigned to them. What advice do you have for accommodating this heavy workload, and sustaining quality outcomes?

There are instances where case managers are being overwhelmed. I typically have 60 patients I’m managing, which comes with non-stop emails, countless return calls to providers, supervisors and family members. I have to pre-plan my year, not just the month, but the year. Missing just one patient can put you behind significantly, and then you’re not in compliance. Another issue I’m seeing with newer case managers is they’re taking things personally. There is an emotional component to the job. Remember to maintain professionalism while having compassion and sympathy for someone. Realize and appreciate your workload and your feelings because we are seeing case managers getting burned out when they don’t see immediate success.

One thing we do at my organization is recognize the victories. Every month we send a success story to the state. For me, getting someone from the nursing home transitioned back to the community and seeing them get better and stronger is a simple, but major success. It can also be a member who is home and getting access to community options, while getting better physically, mentally and maintaining their healthy lifestyle.

October 8-14 is National Case Management Week, a week to recognize the successful achievements and outcomes in case management.

We can partner with you to ensure case managers have the right resources they need to achieve healthier outcomes and increase member satisfaction.

Categories: Caregiver Readiness, Expert Views, Healthcare Segment News