Complex Case Management, back in vogue for a while now -and immortalized by the National Committee on Quality Assurance (NCQA) as the daunting Quality Improvement Standard 7 as a tool to help members with chronic illnesses or long-term complex needs, has a new baby sister (or brother). Meet Transition Case Management (TCM). These programs recognize that many members are mishandled in the healthcare system as they move from one level of care (usually the more acute level) to another. The programs are designed to support these transitions in a manner that ensures the member understands their instructions, has the right medications and knows what to do with them, sees the right provider and is supported adequately in their new setting. Ultimately, the focus of these programs is to ensure smooth transition and prevent readmissions. These programs are a good idea and provide value to the needs of a far broader set of members than the highly complex. The programs may travel under different names such as acute case management, short term case management, advanced discharge planning, readmission prevention and so on. But they all have the same goal in mind – let’s not drop the patient at the discharge door. These programs fit well with patient centered medical home (PCMH) pilots in that many clinics are eager to support members but may not know that the person who belongs in their “home” is in the hospital. Transition Case Management can provide that bridge by helping get the patient in to see their physician.
With the arrival of TCM we get new data and analytic needs. The traditional means of identifying patients using risk scores, diagnoses and high cost data is too little too late for this crowd. Finding TCM candidates requires new sources of data (think hospital discharge notices straight from the hospital finance department), new diagnoses that are not necessarily complex or chronic (think hip replacement), and more frequent analysis (think daily, weekly, monthly at the latest). NCQA’s newest case management standards provide a good framework of transitions of care and those standards require monthly analysis of data.
The good news is that this is a program that makes sense, has potential value for a broader set of members and uses a different type of case management approach – short term problem solving care coordination skills. These programs encourage new thinking, analytic innovation and relationship building relationship with providers. The new sibling is a welcome program and a positive addition to traditional complex case management approaches.