Case managers are essential in helping UT Physicians patients navigate the complexities of the health care system, particularly older adults or those with complex health conditions. Now, our supportive patient advocates have received external recognition that validates their expertise. UT Physicians earned a three-year Case Management Accreditation from the National Committee for Quality Assurance (NCQA) — the highest possible designation for health care organizations.
“This achievement bookends a 10-year journey,” said Logan R. Thornton, DrPH, MPH, executive director of health services delivery/population health and evidence-based practice for UTHealth Houston. “We introduced this role to carry out chronic disease coordination on a limited basis. Little did we know that case managers are now important members of the multidisciplinary care teams we’ve standardized for primary care practices.”
Collaborative excellence
The Case Management team, led by Cheryle DeMaria, MSN, BSN, RN, manager of clinical case management at UT Physicians, worked for 18 months formally establishing and aligning the Clinical Case Management Program with NCQA standards. The program had a procedure manual, training, and auditing in place before accreditation, but UTHealth Houston had to take the next step. DeMaria said they used NCQA Case Management Standards as a guide to develop policies and implement standardized processes for patient identification, assessment, care planning, and monitoring.
Despite having years of experience as a case manager, DeMaria recognized early that trying to accomplish this without the support of her team would be a disservice to the team and the organization. She enlisted the help of every case manager on the team to tackle the challenge. The team rose to the occasion, with some members performing outside their comfort levels. DeMaria said they are now more confident in their abilities as case managers.
“The most significant aspect of this project was the incredible amount of support and collaboration we received to attain this level of recognition,” DeMaria said. “This included the Case Management team, various departments across UT Physicians, and the Healthcare Transformation Initiatives (HTI) department.”
While DeMaria has been through similar experiences throughout her career, none involved standards as stringent or requirements as extensive as NCQA.
Meeting rigorous standards
Xochitl K. Olguin, MBA, CLSSGB, an HTI project manager II, agrees about the value and meaning behind this impressive designation.
“Anytime you attain a national accreditation, it means that your team rose to the challenge to meet the stringent guidelines and requirements,” Olguin said. “This could not be truer than for this endeavor!”
As project manager for this effort, Olguin was charged with collecting information from different departments, keeping the team on track, and uploading the actual reporting and documentation to the NCQA website’s reporting tool. Olguin said reporting on a strict deadline made the last aspect arduous, but the outcome was well worth working 110-plus hours over eight days.
The assistance went beyond the 18 clinical case managers and across the institution. Olguin said this included human resources, marketing and communications, the Epic team, the chief nursing officer, the HTI data team, patient experience, and more.
Value of case managers
Thornton said this recognition acknowledges that chronic disease management doesn’t just occur during the medical visit with a primary care provider. Rather, it continues between visits where case managers monitor, coordinate, and support patients during their journey.
“Case managers are integral in the lives of many patients who juggle multiple conditions that demand an immense amount of self-management, education, and ongoing advocacy,” Thornton said.
Growing as a team
Working together toward this common goal strengthened the Case Management team and lifted their morale and engagement.
“This could not have been accomplished without a strong Case Management team, and each member’s dedication and hard work have truly made a difference,” said Kimberly Alleman, MBA-HM, BSN, RN-BC, chief nursing officer for UT Physicians.
DeMaria strongly encourages others to embrace this type of opportunity even if projects seem unattainable.
“Being able to improve operational efficiency designed to improve patient outcomes has enhanced the reputation of our Clinical Case Management Program,” DeMaria said. “It’s given us a competitive edge in the Houston community.”
