CMs, social workers thrive under triad model.

Abstract

Faced with a case-mix index they knew was too low for their facility, administrators at Vanderbilt University Hospital in Nashville, TN, set about formulating a new, integrated case management model stressing that case management is a process rather than a role. Under the new model, the hospital's old-fashioned utilization review department was brought out of the basement and transformed into a team of utilization management/DRG management professionals who perform concurrent chart reviews and actively manage DRGs, making sure supporting documentation adequately reflects patient severity. The model, based on "triads" of case managers, social workers, and UM staff, allows for some flexibility when responsibilities overlap, yet each professional maintains a separate and distinct focus within the group.