Module E: Key Quality Measurements

CE Credits: 1.75

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The last module looks specifically at how good utilization can translate into better outcomes for patients while also lowering costs for a healthcare organization. First, it examines the sweet spot of healthcare—the right treatment at the right time—and how the concept of value-based purchasing can help hospitals track and achieve those outcomes. Next, the module uses a case study to explain how inefficient care can harm the patient and create costs for the hospital. It also details outcome measures, such as mortality, pressure ulcers and overall patient satisfaction. Last, the module shows how the proper licensure, credentialing and certification—such as from the Case Management Society of America (CMSA) and National Association of Social Workers—equips CMs to navigate the ever-changing healthcare system.

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Learning objectives: After completing this module case managers will be able to:
» Review the intersection of value and quality in healthcare
» Discuss how value-based purchasing affects quality management
» Explain how utilization of resources affects quality of care
» Define the core elements of quality and outcomes measurement and reporting
» Review CM credentials, licensure, certification and practice standards

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Advance your professional practice: As hospital payment systems shift from volume to value, CMs are in prime positions to be change agents for organizational transformation. By understanding where we can work with the team—intervening to prevent delays, monitor process activities and coordinate care—we can help healthcare organizations reduce costs and ensure quality patient outcomes.

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Improve organizational performance: United States hospitals have a lot of room for improvement when it comes to the value we offer patients, both in terms of costs and positive outcomes—and ineffective case management can actually threaten the viability of a healthcare organization’s entire existence. By working with transdisciplinary teams to reduce waste and errors, we can improve the health of our patients and organization.