In healthcare, the long standing presumption has been that the patient has received an almost exclusive focus (i.e. fix this problem and the rest will take care of itself).
It’s easy to understand how that has worked in a Fee-For-Service model environment (e.g. order 5 tests and maybe you will discover issues that 4 tests might not have discovered).
Where we seem to be headed is toward a Performance Based Reimbursement (PBR) model, based on aggregate outcomes and the danger here is that the focus will shift to “measures”.
It will be tempting under PBR to avoid taking on problematic patient populations (i.e. often the very ones who most need help).
With large numbers of patients being serviced, the numbers probably average out but how do healthcare professionals operating under PBR get to where they feel their actions at the individual patient level consistently contribute to better aggregate outcomes?
Traditional case management has relied on mostly qualitative governance for decision making regarding discharge. Given a diagnosed disease, the healthcare professional selects a modality from an inventory of modalities, gains access to pairs of goals/objectives, picks one or more of these, tracks progress toward attainment of goals/objectives and, then, when the time is right, initiates discharge protocols.
All of this is very subjective and could be supplemented with non-intuitive decision support mechanisms, one example of which is a generic Figure Of Merit Matrix that consolidates progress across all goals/objectives.
This model has been described at http://wp.me/pzzpB-iF
You can get a free copy of the spreadsheet that defines the “Adaptive Case Management Earned Value Matrix” model and immediately start to use it across your entire patient population.
You can order it by e-mailing firstname.lastname@example.org or by phoning 450 458 5601.
Considerations for easy use of the model are a) ability to attach individual spreadsheet instances to each patient file for quick access when a particular patient has the focus in your EMR and b) ability to export diagnosis plus tracking of progress information toward the overall case objective for statistical/tabular analysis across different patient populations.