Thursday, September 22, 2011

Nurse Care Managers: The Mortar Holding the Bricks of the Patient Centered Medical Home (PCMH)

It's no secret that the Disease Management Care Blog is an enthusiastic believer in nurse care managers.  In its humble opinion, it makes no difference what "bricks" are used to build a Patient Centered Medical Home, an Accountable Care Organization, a Population Health Management Program or an employer-based care support/wellness initiative, the nurses are the mortar.

Readers can read more on how this specifically works in a DMCB co-authored article titled "The Focus of Case Management Grows" in this on-line version of The Case Management Society of America's (CMSA) Case In Point magazine.

While the manuscript focuses on the PCMH, its lessons can be applied to any corner of primary care:

1. Some patients have higher health care needs, more care gaps and greater risk.  Surveys and analyzing insurance claims and electronic health record data can find them.

2. There are cheap medical  interventions that increase quality and lower costs.  Nurses know about them and, when they're supported by physicians, can champion their use among patients with the most to gain.

3. Most patients want to meaningfully participate in their own care.  This goes to the core of patient centeredness and these nurses know how to harness that energy.

As systems confront the limitations of pay-for-performance, the disappointments of the EHR Kool-Aid, the inertia of Washington-run health care and dwindling budgets, the DMCB is confident that these nurses will finally get the recognition they deserve. What's more, patients will be better off for it.

1 comment:

Bob Bowman said...

Primary care needs more and better primary care nurses that remain with their clinics and patients steadily building team care. What this is called matters less than the result. For best impact this also must be a result for over half of Americans left behind in health access.

The US has about 270,000 primary care nurses - more than all physician primary care numbers combined. The primary care nurse manages primary care before, during, and after health care encounters, typically directs the clinic, trains personnel, insures that patients get needed services despite insurance company or government or other restrictions, and combats massive US health care fragmentation that impairs primary care. Help in all these areas can accomplish substantial improvements in primary care, particularly eliminating the restriction focus that could free up more nurses for patient care.

Figuring out how to manage chronic care and huge costs per person for few is important, but so is extending health access to over 160 million left behind.