CMSA Today - Issue 4, 2021

Still in the context of the COVID-19 pandemic, the need for high-risk groups to remain socially isolated has sparked remote case management initiatives aimed at chronic patients. Using technology, man agers have been remotely accompanying patients utilizing engagement and activation to keep their health conditions under control, to prevent the patient from getting worse or being readmitted, and helping them comply with care plans. In addition, care management companies have begun working with data management and artificial intelligence. The expectation is that, in the coming years, robust algorithms with outcome prediction will be implemented to improve health outcomes, validate hospital admissions, predict case instability, identify alternatives to hospital admission, decrease clinical variability and prevent re-admissions.

Although promising, case management in Brazil is still taking its first steps, and there are still great potentials and challenges. The first challenge is to improve the vis ibility of case management, to demonstrate the ability to solve complex problems that impact sustainable results. These results must go beyond cost savings; they must increase patient safety, improve their experi ence and stimulate higher quality among healthcare services. In this sense, the search for cost reduc tion cannot be dissociated from patient advocacy. Visibility activities need to high light the sustainability of case manage ment in Brazil, being able to ensure: THE RIGHT CARE IN THE RIGHT PLACE AND THE RIGHT TIME. The second challenge is knowledge. Case managers are still unknown in Brazil and tumor located deep in the brain. Drug treat ments failed and the number and intensity of daily seizures increased. In researching options, Professor Dr. Felix Rosenow, Head of the Epilepsy Center at Frankfurt University Hospital, and his team concluded that a new stereotactic laser thermal ablation technol ogy (SLTA) from Medtronic was the only treatment option; however, it was not avail able in Germany. There were attempts to secure the SLTA operation in Australia and France, but they were denied due to the complexity of the operation. Dr. Daniel Curry from the Children’s Hospital of Houston accepted the chal lenge. Xhenisa was successfully treated with Medtronic’s SLTA technique in November 2018 during an eight-hour brain surgery. She spent only one night in the hospital’s inten sive care unit and was then able to return with her parents to a hotel nearby for outpa tient aftercare. The return flight to Germany took place two weeks later. As predicted by Dr. Curry, the number of seizures increased in the first year after surgery. Subsequently, the frequency of seizures steadily declined, and after a year, Xhenisa is now free of sei zures and medication. Success! WHAT WAS YOUR PRIMARY TASK? My primary task was to establish contact with the Children’s Hospital of Houston, to

need to reaffirm their role every day, and demonstrate that their activities are not in competition with other health professionals (doctors). The third challenge is to regulate the practice of case management in Brazil, through regional and national laws. To this end, the need to create a Brazilian Society for the Management of Care (SBCM) is also highlighted, discussing whether, like other countries, other profes sionals may also act as case managers. ■

Francino Azevedo, PhD, MSN, RN, is a case manager, enthusiastic nurse, patient advocate and researcher. He is chief executive officer at MODU

Case Management.

organize flights, negotiate prices with the hospital and, ultimately, to be the liaison for the parents.

HOW WERE YOU ABLE TO SUCCESSFULLY NAVIGATE A

FOREIGN HEALTHCARE SYSTEM? My previous experience with the American healthcare system, which I was able to gain during my university internships as a hospital business administrator at Kaiser Permanente in Los Angeles, and my active membership in the Case Management Society of America came to my aid. WHAT DID YOU DO NEXT? I asked myself why this SLTA system was not available in Germany, specifically at the University Hospital in Frankfurt. The answer, of course, has to do with the DRG hospital reimbursement system and the funding of new and innovative services. If the costs of the SLTA technology are not reflected in the collective agreement system, a hospital cannot bill the service or can only bill with complex individual approvals. Without a selective contractual basis, this is insecure refinancing, with long waiting times for the insured and often the same work for the different cost units. I followed with the question of how would a health maintenance organiza tion in the USA solve such problems for its

AUGUSTO CABRAL/SHUTTERSTOCK.COM

INTERNATIONAL CASE MANAGERS MAKING A DIFFERENCE: GERMANY How One Case Manager Took a Health Insurance Company from Payer to Player BY JOHANN ACHIM BEI ß EL, MHA It is the role of the case manager to advocate for the patient, often going to ex traordinary lengths to secure the necessary treatments. Here, Johann Achim Beißel, a health insurance-based case manager from Germany, describes how he crossed oceans and international borders to navigate his patients’ pathways to health. HOW DID THIS JOURNEY BEGIN? In mid-2018 we had an 8-year-old patient, Xhenisa, suffering from epilepsy caused by a

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CMSA TODAY

Issue 4 • 2021