HCT Consulting was approached by a 350 bed, full-service, for-profit healthcare

provider with the desire to totally revamp their case management department. The
provider felt they were not staffed appropriately and were operating like a case
management department “out of the 1980’s”.

The initial objectives discussed were:

 Provide breakthrough analysis and deep analytical support to selected

initiatives:

 Introduce expertise, approaches and specific knowledge in selected areas while

accelerating implementation in key areas;

 Provide day-to-day program management support; and

 Achieve and sustain the performance impact in the areas of case management
(department structure and operations), Medicare LOS and interdisciplinary
interactions.

We used our unique Transformation Intervention TM process to conduct the assessment,

process redesign & staff training as well as implementation and performance
measurement.

The assessment phase consisted of observations, shadowing, interviews and data

analysis. The targeted areas were departmental infrastructure, education, barriers to
discharge and technology. Also, as a part of the assessment, we were asked to
interview potential candidates for the interim Case Management department director
position and to conduct an objective performance rating of all case managers and
social workers in the department.

The redesign & staff training phase consisted of brainstorming sessions which included
case managers, social workers and nursing. A product of this phase was a
Collaborative Action Plan that was immediately implemented. In addition, a needs
assessment was conducted to identify training and other educational gaps of the
department.

The newly developed action plan was put into place under the guidance of the HCT
consultants. Some key initiatives for departmental infrastructure included:

 Identification of new case management director;

 Transition to unit based assignments;

HealthCare Transformation, LLC.

70 W. Madison, Three First National Plaza, Suite 1400, Chicago, IL 60602
Telephone: 312-214-7216 Fax: 312-214-3110 www.hctconsulting.net
  Delineation of case manager and social workers roles and responsibilities;

 Engagement of a proactive physician leader;

 Establishment of an ED case manager; and

 Creation of a new departmental escalation policy.

Key initiatives for education included:

 Lining up in-services for case management department to be conducted as

“lunch and learns”;

 Education of unit secretaries and HIM on importance of correct discharge

dispositions;

 Ongoing nursing education;

 Community education which included meetings with nursing homes, SNFs and
LTACHS; and

 Utilizing the Physician Leadership Director to conduct ongoing physician

educational sessions.

To tackle some of the barriers to discharge, the tactics included;

 Establishing multidisciplinary daily huddles;

 Helping case managers and social workers to re-prioritize their day;

 Restructuring the complex case review meetings;

 Working closely with Hospitalists to establish responsibility and accountability for

medical staff; and

 Implementing a concurrent coding process.

In the area of technology the focus was:

 Researching automated case management systems (including discharge

planning); and

 Establishing access for all the case managers to KePro I- Exchange and setting
the expectation for daily tracking for Medicaid approvals.
HealthCare Transformation, LLC.
70 W. Madison, Three First National Plaza, Suite 1400, Chicago, IL 60602
Telephone: 312-214-7216 Fax: 312-214-3110 www.hctconsulting.net
For the performance measurement phase we worked very closely with the
Quality/Performance Improvement department as well as the IT department to
establish an extensive dashboard on the facility’s shared drive, allowing the tracking
and trending of measures as well as providing easier access by the Administrative
team.

The hospital was able to make major changes in a short period of time with the
potential of a significant financial impact. The hard savings which were realized rapidly
were part of the department FTE restructure and resulted in a savings of approximately
$200,000. The at-risk reimbursement that was corrected by establishment of new
processes will save the facility $950,000. As a result of changing the delivery model for
case management and implementation of initiatives the facility committed to reducing
Medicare LOS by 0.5 days. This results in a “soft” savings of between $415,000 and
$975,000. The total financial impact for this engagement ends up between $1.5M and
$2.1M.

This facility is serious about sustaining the progress they have made and continuing to
build on that progress. They are still actively implementing improvements and are
working very closely with HCT to help ensure ongoing success.

HealthCare Transformation, LLC.

70 W. Madison, Three First National Plaza, Suite 1400, Chicago, IL 60602
Telephone: 312-214-7216 Fax: 312-214-3110 www.hctconsulting.net