CMSA Today - Issue 4, 2021

program that recruited business profession als to assist schools in applying for the state’s Sterling Award for quality and performance improvement. Since school administrators were not versed in the quality improvement process, business professionals mentored administrators to prepare them to fill this role in the future. I volunteered for 2 years, and this experience opened doors for jobs in quality improvement. As a result, I moved to another hospice organization as their direc tor of quality improvement and compliance. Having the business, quality and nursing background, I chose to work for the Quality Innovation Network, Quality Improvement placement for a patient in the community. While on-site, I make sure that I touch base with triage nurses, rooming staff and other team members to “catch up” or find out what is new in the clinic because personal interest and contact build team relationships. I work with a great team, and I have enjoyed this new experience as an embedded case manager. At a day’s end, I almost always have a sense of satisfaction that I have helped nearly every patient I have touched. One of my most memorable success sto ries as an embedded case manager involved explaining the need for insulin to a diabetic patient with a BG over 600 in the clinic who refused to initiate insulin. We discussed how the insulin would bring his diabetes under control and prevent further complications. When I asked him if he was coming back to his appointment a week later, he said he would. He returned to the clinic a week later and administered his first insulin injection. Five months later, his A1C decreased from >14% to 7.2%. Another memorable experi ence involved working with a patient who had a hypertensive crisis to achieve normal blood pressure. I provided education on home blood pressure monitoring, medica tion management and a heart-healthy diet, emphasizing sodium restriction, including reading food labels. We met weekly for six weeks. His provider titrated his medications as needed to achieve normotensive blood pressure within six weeks. STRATEGIES FOR SUCCESS A comprehensive implementation plan is critical to ensure the success of embedded case management programs in primary care. Continued from page 15

Organization (QIN-QIO) when the oppor tunity presented. In this role I was charged with working with healthcare providers to review data and develop quality action plans to improve patient clinical outcomes, reduce readmissions and reduce costs. In this role I was able to sharpen my skills in analyzing and presenting data to healthcare leaders across the state. Throughout my career I never passed up an opportunity to learn new skills through higher education, work or volunteer experi ence. Doing this opened doors I never real ized would be available. I encourage you to do the same. ■ Nurse case managers have the experience and skills to improve the patient experience, health outcomes and healthcare utilization. An implementation strategy benefits the case manager, providers, the clinic team and the organization. Implementation strategies to consider include: 1. Understanding the clinic’s patient pro file, including demographics, culture and social determinants, to match the right case manager to the population 2. Evaluating clinical leadership knowl edge of the role of case managers and providing education as appropriate 3. Outlining in writing the role of the nurse case manager for every team member to prevent role confusion and to utilize the case manager effectively 4. Setting aside time for the leadership team, clinical team and nurse case manager to meet informally to facilitate the integra tion of a new service into the team 5. Integrating population health modules or technologies into the existing EMR to improve the efficiency of documenta tion and communication to benefit the case manager and the clinical team 6. Utilizing data analytics to extract and process useable data to identify at risk populations at the point of care to allow proactive versus reactive case management 7. Identifying outcome measures to dem onstrate and present the added value of case managers to clinic leadership, the clinic team and the case manager 8. Implementing electronic referrals for case management to increase efficiency and to track referral sources

9. Orienting the case manager within the clinic setting and including the case manager in email distribution lists 10. Equipping the case manager with the training and decision-support tools to meet or exceed performance expecta tions, including identified outcome measures and quality indicators Case managers have a unique and ver satile set of skills that can benefit many care settings. As the U.S. healthcare sys tem transforms, the role of case managers will continue to evolve. Primary care is a great place. The availability of post-acute care services has already changed the healthcare landscape. As accountable care organizations increase and reimbursement models continue to reward performance and quality outcomes, case managers are equipped and prepared to provide high quality, value-added professional case management service in any setting. ■

Kelva Edmunds-Waller, MSN, RN, CCM, has more than 37 years of nursing experience, including more than 20 years in leadership roles.

She has clinical experience in acute care, home health, infusion therapy, public health, managed care and long-term acute care. She is currently pursuing a DNP degree at Loyola University New Orleans and will complete the program in the summer of 2021. As president of the Central Virginia Chapter of CMSA, she promotes and advocates professional case management practice.

Edna B. Clifton, MBA, BSN, RN, is a registered nurse with more than 30 experience in healthcare. She is currently an independent

consultant with expertise in quality improvement and accreditation. She is also the ANCC lead nurse planner for Athena Forum Institute. Her focus has been quality improvement in a variety of healthcare settings including acute care hospital, home health and hospice. Feel free to reach out to Edna via email at Edna.Clifton@athenaforum.net .

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CMSA TODAY

Issue 4 • 2021