In addition to the nurses, physicians, and other clinical providers who care for patients in the hospital, the care management staff serves as a resource to patients throughout their hospital stays. At the heart of this multidisciplinary team is a commitment to high-quality, cost-effective outcomes for every patient.Three primary roles exist in the field of care management: care manager, social worker, and clinical documentation integrity specialist (CDIS). Together, these three positions follow a patient’s diagnosis and treatment to ensure that evidence-based protocols are being implemented according to best practices.
Care management staff provide clinical assessment, patient education, and discharge planning, among other tasks. For example, a social worker meets with patients and/or families who need resources after discharge. Keeping the patient at the center of the care plan is at the core of care management.
“Our work relies on Bayhealth’s values of patient- and family-centered practices. We are focused on listening to patients and their families as much we are involved in choices about the patients’ care,” said Lynn Davis, MSW, Bayhealth manager of Social Services.
Care management team members also play an important role in coordination with insurance companies, often referred to as “payors” in the health care context. Because most hospital patients rely on their health insurance companies to pay a portion of the costs associated with treatment, it is essential that diagnosis and treatment are clearly and accurately documented.
Many payors set limits on the type of care or the length of hospital stay associated with various health conditions. A care manager verifies that the payor receives accurate information about each patient so that coverage can be applied appropriately.
Most professionals who work in the care management field have at least five years of experience as registered nurses or have a bachelor’s or master’s degree in social work.
“Hospital care managers play a vital role in managing health care transitions across multiple providers throughout the continuum of care, while also balancing the responsibility to serve as advocate for both the patient and the health care system. As health care continues its transformation, care management has become even more essential to the care process. This week is an opportunity to recognize the dedication, compassion, and outcomes achieved by care managers,” said Eric Gloss, DO, Bayhealth’s vice president of medical affairs.
In order to honor its 47 employees, the care management department at Bayhealth will hold special events throughout the week. There will be a daily display in the hospital to provide education about the role of care management at Bayhealth.