Yesterday's Main Session 

Following a video introduction, Allan Hamilton, MD, FACS, took the stage to discuss the current, troubled state of healthcare and what role case managers can play in improving it.

 He noted that while the United States outspends every other nation on healthcare, its ranking in terms of healthcare quality is much lower. A significant percentage of the population is in either Medicare or Medicare, and out-of-pocket expenses among U.S. healthcare consumers continue to increase.

 Meanwhile, hospitals are buying up private practices, fee-for-service payment can incentivize overutilization, and the ER is too often being used for primary care. The average daily cost of a hospital stay was 6,000 percent higher in 2012 than it was in 1958, and hospitals are operating on margins of only 2.5 percent.

 So what can be done to improve healthcare? According to Hamilton, what’s needed is a shift from interventional to preventive care. Value-based payment, which provides incentives to be more efficient, can be part of the solution.

 He added that case managers are in the driver’s seat when it comes to facilitating positive change. "There really is no one else who could help drive the team and delivery of hospital and post-discharge services," he said. He added, "CMs need to become identified as an agent for change."