Jennifer Schmidt

Moving from Case Management to Care Management

Co-Authored by Jacob Brancasi, Experience Design Leader at Business Innovation Factory

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Where We Are Today

Health system practices have largely been based on a ‘treatment imperative’ with the goal being to identify or diagnose current problems; be it clinical, social or otherwise; without looking towards external factors or determinants. This treatment imperative has created a myopic view of health, one in which clinical walls and medical care are our default solutions.

Moving away from a one-dimensional medical only view of health to a multidimensional approach that embodies multi-sector perspectives and partnerships is a promising next practice, one that we in the Patient Experience Lab (PXL) have been thinking about, writing about and working towards with organizations and institutional leaders across the health space.

‘Spotlighting’ a Promising Next Practice

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Recently we got to know Hudson River Healthcare (HRH); an organization comprised of 28 separate Federally Qualified Health Centers in New York State, a model of this multidimensional approach that embodies multi-sector perspectives and partnerships. HRH has been addressing the varying needs of complex patients, whose care was fractured and isolated across the clinical and social spaces, resulting in poor care, ever-increasing costs, and the continuation of underlying unmet social need.

To create a more complete and empathetic path to wellness for its patients, Hudson River Healthcare worked with the Health Care Transformation Task Force to develop a social integration framework that offers a series of steps including a comprehensive population assessment, and alignment around measures of success.

With their social integration framework, HRH is helping social services and clinical organizations such as Solutions 4 Community Health, The Preservation Company, and Family Health ACO, work together to create shared partnerships across sectors with shared risk, responsibility, and reward. These partnerships enable an overall shift in mentality from case management to care management, empowering individuals and families to be involved in the creation of their own personalized care plan and spurring sustained community engagement in the creation of healthy and safe environments for individuals and families.

The Collective Path Forward

At Business Innovation Factory (BIF), we believe that this established, sustained focus on including the patient experience and integrating social services and health is a promising next practice to transform the path to health and wellness to deliver new experiences and values for individuals and families.

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Exploring the viability of next practices and working with leaders to bring those models to scale is a bedrock principle for the Patient Experience Lab team at BIF. The path to social system transformation moves up a transformation hierarchy and starts with combining and recombining capabilities into next practices and new models. This transformational path will be the most sustaining catalyst for real change in our social systems, including Healthcare.

BIF embraces cross-sector solutions as one of many ways to move from incremental to transformational change, and our mission is reinforced when organizations such as HRH move away from the treatment imperative and drive actionable, measurable change by getting off the whiteboard and into the real world with new cross-sector models that extend beyond the conventional medical models and frameworks.

That is at the core of our methodology, and at the heart of the work that we do.

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Putting It Into Practice

Bringing our methodology into the real world every day is what drives the work of the PXL. Our multidisciplinary team of in-house Experience Designers (EDs) is the engine of the PXL lab, spending their time in the field and on the ground seeing and hearing what really matters to individuals and families when working towards transforming the health of our communities. By prototyping next practices with real individuals, families, and providers in their unique contexts, our EDs help institutions shift their lens, and take these next practices off the whiteboard and into the real world.

In the PXL, we work side by side with health system leaders every day to advocate for a broader view of health, focusing on more than sick care and treatment imperatives. This collaborative effort has fostered healthy communities and is reinforced by work such as the HRHCare’s initiative; demonstrating the benefit of bringing a social integration model to scale.

Work like this so often stays at a prototypical level, because leaders haven’t had a set path to scale it in the marketplace. Through contractual relationships and delegated community partnerships, HRH has been able to truly pilot this work at scale by defining common priorities and setting specific responsibilities with the 45 Care Management Agencies with whom they partners. These partnerships act as small prototypes, amplifying the community-based expertise, and bringing the work of HRHCare to a new and greater level of impact.

The Impact

Through this next practice of a multidimensional approach that embodies multi-sector perspectives, we see transformational change happening. By adding new value and creating a path to wellness for individuals and families; ‘whole person’ determinants of health are being addressed at scale, with measurable impact.

We’re excited by organizations moving away from the treatment imperative towards a ‘wellness imperative’, where clinical, mental, and social are combined to create a truly holistic approach to health. By spotlighting promising next practices and organizations like HRH that are pursuing multi-sector models of health, we will, together, transform our health system at scale.

 

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