Innovating case management for the chronically ill
16 Sep 2015
Case management is already used to reintegrate acute illness suffers back into society. Extending the technique into chronic conditions could bring significant cost savings.
Patients are frequently unprepared and overwhelmed by the onset of a chronic illness. They often lack quality care to help them deal with their condition and cope with the challenges of daily living. Insurance can provide immediate financial support; assistant services are also required to ease the onset of the illness. These include: personal consultations for the chronically ill; access to a second opinion in the event of an accident or illness; general health care advice; and individual care planning. With chronically ill patients, optimal advice and care are major factors in assuring treatment efficacy and social and professional reintegration within a minimal amount of time.
Case management as a potential solution
Case management models for managing accidental injury, for example, seek to achieve reintegration post-accident through personalised care and coordination of the service providers involved. Case managers accompany their client throughout the entire treatment process but mainly focus on acute disease and accident management of the working age population. Such models have been successfully applied in Switzerland for some time; and there is the potential to bring this concept to other sectors of the healthcare system, such as chronic conditions.
Innovating management of the chronically ill
Under a case management system specifically targeting the chronically ill, patients should be registered as soon as possible post-diagnosis to ensure optimal management of their condition. They can thereby reduce the amount of time required in nursing care or prevent the need for any care. Ultimately, the aim is to build patients' confidence in living with their condition, enhance their quality of life and prevent any health complications. Case-by-case assessments and assistance services allowing them to remain employed and receiving care, insurance benefits and counselling would accelerate the social and professional reintegration of chronically ill patients.
Future case management models could be based on existing patient reintegration programmes after an illness or accident. However, these would need to be more closely aligned with the needs of the chronically ill and care for patients older than 65 years of age. The same assistance services would need to be available to elderly patients, moreover, such as coordination of acute care in an emergency. Other top priorities should include setting up a telephone helpline, organising home care and providing personalised advice on matters of daily living, such as maintaining independence. Ultimately, strengthening case management for chronic conditions would significantly help prevent the need for long-term nursing care - or at least minimising the care period and the cost of care. Key to case management is an interdisciplinary and multidimensional assessment of the kinds and level of assistance needed. The care is personalised and covers the following aspects:
Medical: medical history, choice of therapy, treatment programme
Professional: job retention and job adaptation, retraining, job search
Psychosocial: counselling, life coping skills, social support system, mobility
Financial: clarification and coordination of insurance benefits
In addition to the case manager, patient case management should involve their medical providers, social insurance providers, next of kin, employers and private insurers. Case management would be performed by an independent company mandated by an insurer or the employer of the patient concerned.
Who would benefit?
As all stakeholders – patient, insurer and employer alike – stand to benefit from efficient and preventive case management, such a project should be joint financed. Efficient case management would trim general healthcare costs as well as reduce disability pension liabilities and daily benefits, as patients return to work sooner. Providers of private supplementary insurance could redeploy these savings to fund independent case management firms. Another potential funding vehicle might be a new private insurance product to cover the case manager's administrative expenses in the event of a chronic condition. This could be a critical illness product, for example, which in the event of a clearly defined medical condition pays out a once-off lump sum to cover the additional care requirements. The premium would be paid in the first instance by the covered individual; however, with chronic diseases increasingly contributing to work absences, employers might be expected to also contribute to the cost of insurance.
Case management models to build on from
The approach is already being used by a number of insurers in Switzerland. SuvaCare's New Case Management in particular has served as a template for other insurers' programmes. As an accident insurer, Suva covers the medical treatment and care costs of its policyholders as well as their daily benefits. It is in the company's interests therefore to curtail or optimise these costs. One example of an independent, established case management firm is ReIntra, a German company successfully operating in this business since 1996. In Switzerland, Activita – a company founded in 2001 by Suva, Allianz, Winterthur and Zurich Insurance – is considered a pioneer in case management.
As technology continues to make inroads into healthcare - from wearable sensor devices to healthcare apps as well as technical systems to support elderly people in their daily routine - professional case managers gain new tools to enhance their practice and work even more effectively with their patients.
Intended as an idea catalyst to improve patient care, this article was first published in the book «Hacking Healthcare» by the Swiss Think Tank W.I.R.E. aimed at understanding and developing the healthcare system: http://www.thewire.ch/de/publications/hacking-healthcare.
Hacking Healthcare - Das Gesundheitssystem verstehen und weiterdenken, by S. Sigrist, N. Bornstein, K. Lesmono, A. Dür, G. Folkers; Zurich: Neue Zürcher Zeitung; ISBN: 978-3-03823-655-9; in German.
Studie «Assistance Barometer» (2015). URL: www.assistancebarometer.de.
The Boston Consulting Group (2010). Case Management und seine strategische Bedeutung für Versicherer. Januar 2010.
Christoph Nabholz was a speaker at the Centre's conference Transforming healthcare: Telemedicine, best practice and you.
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