Clinical care must be standardized, process oriented, and tracked (documented and assessed) in order to achieve the efficiency and effectiveness called for in healthcare. There is no getting around that. However, when completing the process itself becomes the goal, as opposed to achieving the outcomes that the patient needs, much is lost. Being able to “click the box” that an intervention was offered or attempted, without the follow up to ensure that that intervention is appropriate or effective, is not enough. A recent re-examination of the Camden Core Model from the Camden Coalition illustrated that for me.
The Camden Core Model – a robust care management program for people with complex medical and social needs that has stood as a best practice standard – was examined in 2020 and no impact on acute utilization was found. However, in 2023 the program was re-examined more closely, and a significant reduction of utilization was found for participants “most likely to engage”. That means that the participants who engaged in the program, as measured by the number of hours meeting with the program’s staff in the first week after a hospital discharge, saw better outcomes. That just makes sense and shows that the program does work for those who receive the services. Pretty obvious. What is different here is that the Camden Coalition then looked at what determined likeliness to engage. Instead of blaming the victim and thinking “well if only they engaged with us, they’d be better off”, they looked at what defined those less likely to engage. They found that people who had been arrested prior to enrollment, were hospitalized more than 3 times in the prior 6 months, or had unstable housing were least likely to engage. Then, instead of writing those populations off, they invested in a Medical-Legal Partnership program, partnered with a local addition medicine clinic, and developed a Housing First program. They took the next step. They met the client where they are at and did what needed to be done to create meaningful change.
Too often, we get lost in the focus of doing what needs to be done and lose sight of what should be done. If going through the processes to the same extent for everyone worked, we wouldn’t be dealing with the issues we now see in healthcare. However, by looking at people holistically and knowing that sometimes needs go beyond what is captured in the chart or in a drop-down box, real change can be achieved. Work like that is hard. Sometimes it’s not possible. But when it is, that’s when the magic happens and the mission is met.
“Analysis Explores Nuanced Impact of Camden Coalition Care Management Intervention: Takeaways for the Field” by Logan Kelly, posted by The Better Care Playbook on September 27, 2023 and available at: https://www.bettercareplaybook.org/_blog/2023/27/analysis-explores-nuanced-impact-camden-coalition-care-management-intervention