Every patient who enters the new Martin Luther King Jr. Community Hospital in South Los Angeles is guaranteed one thing: A care manager.
Spurred by the Affordable Care Act's financial incentives to keep people healthy, MLK Hospital is assigning one of these advocates to help each patient from the time he walks in the door, through the course of his treatment and beyond.
Care managers have been around for about a century, but experts in the field say MLK's approach marks a dramatic expansion of their traditional role.
Also referred to as care coordinators, patient navigators, transition coaches and guided care nurses, care managers are healthcare professionals, mainly registered nurses and social workers, who have earned additional certification.
MLK Hospital's care managers help patients understand their condition, their care and what they need both in and out of the hospital, said the facility's Chief Nursing Officer Myrna Allen, who set up the new system.
"I have 24/7 care managers, and they are assigned the minute a patient is interested in coming here," she said. "We start the process at that time because I didn’t want a patient to come in on Thursday and we don’t know they are here until Tuesday and they are ready to go home on Wednesday and we are not ready for that."
"They may need a shelter" or rehab
She said the intention is to follow each patient through the entire course of his treatment, regardless of whether he is admitted to the hospital, and for as much time as needed afterward to make sure he follows treatment plans, gets his medications, and makes it to follow-up appointments.
MLK’s care managers will also "contact your provider within a certain amount of time to see if you are following orders" and in some cases will call the patient "a couple of months later ... to make sure you are still well," said hospital spokeswoman Beatriz Mallory.
This use of care managers can be particularly helpful for people in underserved low-income communities such as those that surround MLK Hospital's Willowbrook complex, Mallory said.
A number of patients will need a registered nurse and a social worker involved in their care management, noted Allen.
"They may need a shelter, they may need to know how to get to a food bank, or they may need to know how to get to public assistance," she said. "They may need the rehab, they may need the mental health."
MLK Hospital has 10 care managers on staff now and plans to have 20 by the end of the year, said Mallory.
The new 131-bed hospital opened last week, eight years after controversies over poor management and patient care forced the closure of King/Drew Medical Center on the same site.
A check of a number of area hospitals found they use care managers, but in a more limited manner.
- At UCLA's hospitals, care coordinators are assigned to patients with complex cases, such as those who have visited the ER multiple times, those with several chronic conditions or those who don’t have a support system.
- At Cedars-Sinai Medical Center, nurse navigators help patients diagnosed with cancer, mostly women treated at its Breast Center.
- Kaiser Permanente offers care management in specific areas, such as its diabetes care management program.
A shift prompted by the ACA
While care management is not new, it has expanded significantly and received newfound attention thanks to the Affordable Care Act, said Cheri Lattimer, executive director of the Care Managers Society of America.
As health care has moved from a fee-for-service model to a system that rewards high-quality care, medical centers and other health care providers are looking for strategies to keep people from having to return to the hospital after getting their original care.
That has shifted how care managers work.
"You used to see a care manager at the end of the stay," Lattimer said. For the most part, care managers saw patients just before discharge to review prescriptions, outline post-hospital care and for referrals.
The practice started evolving within the last five years, said Lattimer, adding, "Now we are at the very beginning and throughout, not just at the end."
Care managers have been around since the early 1900s, she said, and their responsibilities changed with the times. During World War I and World War II they worked mainly with injured soldiers.
Demand for care managers is on the rise, Lattimer said. She said she gets calls regularly from providers asking her for staffing help.
Currently it's unclear how many care managers there are in the U.S. – the Bureau of Labor Statistics does not track them as a professional category.
The Care Managers Society of America estimates there are at least 150,000, based on figures from various organizations' membership rolls and the number of those certified by authorized programs.