Case Management at Houston Methodist Healthcare Institution

Houston Methodist is a leading healthcare institution in the United States (About Houston Methodist, 2016). The organization provides “a wide range of health services to more patients in the Greater Houston Area” (About Houston Methodist, 2016, para. 2). The hospital’s major centers are characterized by qualified members of staff. The institution uses its ICARE values to empower its workers. The ICARE model stands for “integrity, compassion, accountability, respect, and excellence” (About Houston Methodist, 2016, para. 3). The major priorities include integrity, safety, and quality of care. Since the hospital provides adequate care to more patients from diverse backgrounds, it always embraces the use of Case Management (CM). Huber (2014) defines Case Management as the collaborative approach whereby caregivers assess, facilitate, plan, coordinate, and advocate for the best services to address the needs of every patient. In order to deliver positive results, CM is guided by effective communication and use of adequate resource. This discussion examines how Houston Methodist implements and uses the Case Management concept.

Houston Methodist’s Case Management Program

At Houston Methodist, a number of programs are implemented and used in order to support the diverse health needs of many patients. One of these programs is known as Case Management (CM). This program is characterized by four unique steps. On top of the CM program is the Case Manager. This position is available in every center in order to ensure more patients receive quality care. The first stage is identification of the targeted clients. During this phase, the healthcare professionals identify specific patients whose needs must be addressed (Kisokanth, Prathapan, Indrakumar, & Joseph, 2015). This stage is used to assess the problem and examine if the right resources are available.

The Case Manager goes further to establish the best goals that must be met using desirable health intervention processes. The institution uses this second stage to outline the procedures and approaches that can deliver sustainable results. The third stage of the CM focuses on the coordination and implementation of the outlined healthcare services. During this phase, the institution implements the Case Management plan in order to support the needs of the targeted patients. The other important thing considered during this phase is the continuous evaluation of the health services available to the admitted patients (About Houston Methodist, 2016). The status of every client is monitored in order to make desirable adjustments during the healthcare delivery process.

The “final phase is the termination of the Case Management process” (About Houston Methodist, 2016, para. 6). During this phase, the healthcare professionals monitor the effectiveness of the healthcare delivery process before ending it. This stage is used to ensure new measures are implemented to provide quality medical support to more patients. The program is concluded after the patient has recorded positive outcomes. The use of these phases explains why Houston Methodist continues to deliver desirable medical services to more people in the region.

Comparing Houston Methodist’s CM Program With that of a Model Facility

Mayo Clinic Health System is a model facility that is revered by many people across the United States. This non-profit healthcare facility has one of the best CM programs in the country’s health sector. The first thing to consider is that the institution has a Social Services and Case Management (SSCM) department. The role of this department is to address the medical and financial needs of every patient. In order to operate optimally, the department is comprised by social workers, nurses, and physicians who can support the needs of patients (Mayo Clinic Health System, 2016).

The six key steps of the Case Management program are embraced in this institution. The first step is known as client identification. This stage is used to obtain consent and determine if the institution can deliver positive health services. The second phase is opportunity identification. This process is conducted in order to ensure the patient is supported by the program. The next stage is the development of the CM plan (Mayo Clinic Health System, 2016). During this stage, the needs of the targeted patient are prioritized. This knowledge makes it easier for the workers to match the needs with the available resources.

The fourth stage is the coordination of care. This stage focuses on the best strategies to support the implementation of the program. The fifth stage is evaluation and follow-up (Mayo Clinic Health System, 2016). The stage is used to evaluate the health status of the patients. The final stage is known as termination. The CM plan is ended during this stage. However, the outcomes of the patients are used to determine when the program should be halted.

Several differences can be observed between the CM program of Mayo Clinic and Houston Methodist. At Mayo Clinic, the six phases are carefully implemented while Houston Methodist uses only four. The institution is always on the frontline to use of the Utilization Review (UR) concept. The approach is used at Mayo Clinic to review the nature of patient support and improve future services. The other lesson gained from Mayo Clinic is that its CM program is extended to the patients after being discharged (Mayo Clinic Health System, 2016). The facility collaborates with social workers and members of the community to maximize the outcomes of the discharged patients.

From this comparative analysis, it is agreeable that Houston Methodist adheres to the recognized standard for CM. This is the case because the available resources are matched with the unique needs of the targeted clients. The other issue is that the issue of disease state management is taken seriously. Such measures have made it easier for Houston Methodist to deliver quality patient services (Mayo Clinic Health System, 2016). However, there is still room for improvement in order to make Houston Methodist successful.

Quality Assurance Program

Houston Methodist uses a powerful Quality Assurance (QA) program to support the needs of the targeted patients. This QA program is supported by the above CM plan. The CM approach outlines the best procedures to ensure the targeted patients receive quality and timely medical services. The institution has a QA department that focuses on the quality of services available to the patients (Huber, 2014). The role of the CM program is to ensure every patient receives quality health support. During the process, continuous assessment is done in order to monitor the experiences of the clients.

The institution has been on the frontline to use the concept of lean (About Houston Methodist, 2016). This model guides the institution to outline the major strengths in its Quality Assurance program. The existing gaps are addressed in order to ensure the facility delivers desirable care to its patients. The QA manager equips the health workers with the right skills and resources in an attempt to transform the experiences of more patients. The QA program at Houston Methodist supports the outcomes of more patients in the region (Patel, 2014). The Case Manager at the institution facilitates communication with payers in order to maximize the patients’ health care benefits. This practice explains why the institution’s health services are admired by many people in the region.

Key Areas for Improvement

The ultimate goal of every healthcare delivery model is to maximize the outcomes of every patient. Healthcare facilities that want to deliver quality medical care to their clients must embrace the use of different models and processes. Houston Methodist has implemented several frameworks in order to deliver quality patient care. It should be observed that Houston Methodist’s Case Management (CM) program makes it easier for more patients to receive quality medical care (Case Management Society of America, 2010). The organization uses powerful initiatives and processes to support the CM program. However, some adjustments and improvements can play a positive role towards improving the quality of patient support and care.

The first proposal is collaborating with community members and social workers to extend the program even after a patient is discharged. This process will support the health needs of many patients with terminal conditions such as diabetes (Kisokanth et al., 2015). Utilization Review (UR) should become part of the CM program. The UR process will become “a powerful safeguard against inappropriate medical care processes and medical resources” (Patel, 2014, p. 3). By so doing, Houston Methodist will find it easier to support the changing needs of more patients in the region. This practice will eventually make Houston Methodist a leading provider of sustainable healthcare services to the greatest number of clients.

References

About Houston Methodist. (2016). Web.

Case Management Society of America. (2010). Standards of practice for case management. Web.

Huber, D. (2014). Leadership nursing care management. New York, NY: Elsevier.

Kisokanth, G., Prathapan, S., Indrakumar, J., & Joseph, J. (2015). Does nurse case management improve the health care outcomes of patients with non-communicable diseases (NCDs): A narrative review. International Journal of Endocrinology and Metabolic Disorders, 1(2), 1-7.

Mayo Clinic Health System. (2016). Web.

Patel, G. (2014). Total quality management in healthcare. Biomedical Projects, 1(1), 1-4.