Evolutions & Solutions: Exploring Case Management Models.

by XSOLIS Insights, on Oct 21, 2020 6:00:00 AM

Your hospital or health system’s case management model – dyad, triad, or something in between – dictates incredibly important things: staffing ratios, review processes, technology needs, and much more. Knowing this, the question then becomes, how can each organization find the model that best serves their staff and their patients? Leaders of health system case management explored this central question during a recent panel discussion as part of the XCHANGE 2020 virtual event.  

While weighing each model's pros and cons, it became clear that it's not necessarily an either-or issue. Taking a cue from one of our panelists, we turned this topic on its side and discovered it isn't about which model is right but rather how can you tweak these models to make them more effective for your work environment, your patient population, and your organizational size. 

How can you re-design your current case management model into one that will work for your specific needs inside your specific healthcare system? And does that solution maximize communication and collaboration?  

One health system’s solution turned everything you thought you knew about the triad model literally on its side. But before we explore that, we’ll look at the two most common models: dyad and triad. 

The Two Models 

One size does not fit all, so there is no perfect fit for each case management model.  Panelists discussed the pros and cons of the models they use, and no matter the model, there was one common struggle they all still faced: communication. 

Here’s a look at how each model works: 

The Integrated (Dyad) Model 

Typically has a single manager (Nurse Case Manager) responsible for overseeing all three functions for a given patient, including UM< care coordination, and discharge planning. Smaller hospitals and healthcare systems favor this model. 

The Collaborative (Triad) Model

Traditionally assigns different case management functions to different managers. So, a case management department may have one RN handle utilization review, another coordinating care & discharge planning, and a social worker handling psychosocial assessments and high-risk discharges. Larger hospitals and health systems favor this model. 

While there are benefits to each, depending on the size of the healthcare system, the panelists agreed that communication and collaboration were obstacles they faced – silos often arise from differing reporting structures, unclear outcomes, downstream workloads, and more.   

Thinking Sideways 

While trying to find a better way for case management models to work is a big task to tackle, sometimes one simple act can be the catalyst to the change you need. For Hillcrest HealthCare System, a moment of frustration about the continuous struggle of dealing with inefficient processes due to siloed communication lead to reimaging the triad model... sideways.  

It’s called the Right Care Model, based on the five rights of resource management. 

The way the model is different than any other model is that it really takes a holistic approach to patients,” said Michelle Allen, Director of Case Management for Hillcrest Medical Center. 

The results of implementing the Right Care Model? Hillcrest HealthCare saw a reduction in length of stays, a reduction of readmissions, and a significant spike in patient satisfaction.  

But Hillcrest HealthCare says this model would not be able to exist without XSOLIS’ CORTEX technology platform.Because the model is labor-intensive, the artificial intelligence and machine learning XSOLIS provide in driving the UR process is critical in implementing the model.  

We went live in June with CORTEX and the team really liked this model of case management, but it was very manual,” shared Michelle. “So, going to the CORTEX platform has helped the team adapt easier and helped make this model work.”   

To hear more about what it took to put it into action and learn about the steps you should take to start a change in your organization successfully with XSOLIS, you can watch the full discussion here.