Baptist Health Redesigns Case Management to Reduce Readmissions

Penny Gilbert, MSN, MBA, BSM, RN, CPHQ, Director, ACC, Case Management, Social Services and Transport Team, Baptist Health. The rising cost of healthcare along with pay-for-performance and bundled-payment initiatives have affirmed the importance of case management in today’s healthcare market. Case managers have historically functioned as gatekeepers regarding patient length of stay (LOS) and cost per case. Case managers at Baptist Health-Lexington recognized the need to move beyond the traditional case management roles and activities related to discharge planning, utilization review, and LOS management. Effective transition from hospital to home or supportive agency is a major component of this case management model. A decision support analyst developed a) the database using internal software, b) the reports required to extract the needed data elements for the calculations, and c) the report retrieved daily by case management, which will also be discussed.