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	Strategies for Success:  MANAGED CARE
	Managed care will continue to be a central topic in the national debate on health care costs. Regardless of the current penetration of managed care into your hospital's market, planning and implementing effective case management now will help to ensure success in your inevitable competition for managed care contracts. Health Systems Management Network believes that effective case management is the key to managed care and will benefit the hospital, payor, patient and physician alike.  Case Management  Success in the managed care arena depends primarily upon an active case management system. Your entire staff must work to ensure that all processes, from pre-admission to billing, are integrated into a continuum of care to ensure that length of stay is appropriate for each case and that no more or less resources are allocated than are required. The reality is that this ideal often seems unattainable. The complexities of changing payor requirements and patient acuities and complications stress every hospital's case management system. Through successful engagements at many acute care hospitals and integrated delivery systems, Health Systems Management Network has shown that there are certain essential elements in the development of an active case management system. Among these are the coordination of care, clinical documentation, accurate data on utilization, clinical benchmarks and critical paths. A comprehensive management plan and detailed organizational support are key to the integration of all case management methods. Health Systems Management Network can assist you in developing the management plan, the organization and documentation systems to allow you to confidently negotiate managed care contracts and find financial success in their fulfillment.
	Critical Paths Critical paths have been shown to reduce costs, expedite reimbursement and enhance patient satisfaction. The development of critical paths is a four-step, iterative process. The process of selecting principal diagnoses and procedures for critical path analysis is a strategic one. Market demands, payor requirements and a detailed analysis of clinical practice through medical-record reviews must be weighed. Your institution's history on data such as length of stay and resource utilization should be examined against national, regional and competitive statistics to determine which procedures are likely to benefit the most. The second step is the assignment of a team to write a model critical path. We have found that this team should include medical, nursing, UR, quality and medical records staff. When a preliminary critical path has been developed, it should be pilot tested. Testing, with careful documentation, will allow the team to evaluate and revise its work. This process is a clear example of continuous quality improvement. But the importance of accurate and timely documentation to this process cannot be overstressed. Case management based on critical paths is a powerful tool for dramatic cost efficiencies. Effective documentation will allow for quicker development of a case management system and specific critical paths, better tracking of variances between actual care and that specified on the critical path, increased patient awareness and satisfaction, and enhanced revenue through careful tracking of complications and co-morbidities, improved resource management, reduced length of stay and strategic competitive advantages.
	Results-Oriented Services  The development of a case management system is hospital-specific. As critical paths must avoid the perception of "cookbook" medicine, Health Systems Management Network believes that there is no cookbook for a case management system. Although we draw upon wide experience in acute care hospitals and integrated delivery, our work with you is based completely upon the realities of your institution and its market. In addition to our action-oriented management report, our engagement can include "hands-on" assistance in the implementation of our recommendations, thorough training and periodic progress reviews.
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Health Systems Management Network, Inc. is a healthcare consulting firm specializing in the following practices: healthcare consultants; consulting. managed care. subacute care, patient flow, information systems. electronic patient record management. Electronic medical records, billing,insurance, acute care, case mix, case management, ambulatory care, and resource management are areas of experience. We are familiar with UB, length of stay, DRG, in patient, out patient and TQM methods. More recently Health Systems Management Network, Inc has been pioneering work with APC, (All Patient Grouper). clinical data, clinical documentation. benchmarking. critical paths and receivables. We work with utilization review. acute care hospitals. practice groups. ICD, ICD-9, ICD-9-CM, CPT, CPT-4, HCPCS, HCFA, medicare, referrals. JCAHO, claims, RBRVS, HMO, reimbursement, Joint Commission compliance, regulations, training, reengineering, (re-engineering) total quality management for both inpatient, outpatient.