This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with ACMA President Patti Velky who joins us for Season 4, Episode 1 to share her insights on navigating complex patient transitions.

The conversation revolves around three case studies highlighting the complexities of patient care transitions, medical necessity decisions, and systemic barriers in healthcare. The first case examines an elderly dementia patient experiencing frequent hospitalizations, emphasizing the challenges of coordinating care and determining the most appropriate long-term setting. The second case features a 30-year-old patient with severe neurological impairments and bowel obstruction, focusing on inpatient versus outpatient treatment decisions and the role of caregivers in medical management. The third case explores a medically complex patient facing insurance denials for a necessary procedure, underscoring the impact of documentation, coding issues, and advocacy in securing appropriate care. The discussion highlights the critical role of interdisciplinary collaboration, proactive care planning, and system navigation in optimizing patient outcomes.

The Association of Physician Leadership in Care Management, or APLCM, was created to provide support and education for physicians in this field. APLCM is unique because of its connection to the American Case Management Association, focusing on the partnership and collaborative model of nurse case managers, social workers, and physicians in care management. ACMA has a rich, 25-year history of supporting the case management field.

APLCM is inclusive of all practice settings. Membership in APLCM also gives you access to all ACMA resources and benefits. Whether you're new to case management or have years of experience, APLCM membership is valuable. Gain access to professional networking opportunities and resources. Visit www.aplcm.org to learn more.

Please visit www.acmaweb.org/podcast for more information about the podcast, or contact us directly at [email protected] with questions, topic requests, or other feedback.