Care Management at New York-Presbyterian: An Opportunity for Change

Care management is a collaborative process of assessment, planning, facilitation, and advocacy to meet a patient's health needs through communication and available resources to promote quality, cost-effective outcomes. At New York-Presbyterian Hospital, care management is organized and addressed differently at its two largest campuses, Columbia and Cornell. The Capstone team performed a current state assessment of care management at these campuses for the adult medical/surgical populations. Interviews were performed with members of the multidisciplinary team - Social Workers, Care Coordinators, Physicians, and Nurses - who coordinate care management for patients across the cardiac service lines. Additionally, a comprehensive literature review was conducted to identify industry best practices, and three institutions that were identified as embodying these practices were visited by team members. The team synthesized these findings to recommend a care management model that promotes efficiency of resources and quality outcomes for the population studied.