Patient-centered complex care program
April 1, 2002 2 minutes read
Patient-centered complex care program
If a patient wants it, CMs try to get it
If patients in Franklin Health’s Complex Care Management program want something, the care manager will make every effort to see that they get it — whether it’s covered by the insurance plan or not.
"This is truly a patient-centered program. The Franklin care manager works with the patients to determine their goals and is dedicated to helping meet these goals even though the goal may not be something covered by the patient’s health insurance," says Catherine Beatty, RN, MSN, manager, medical services for BlueCross BlueShield of South Carolina, based in Columbia.
For instance, one patient wanted to try alternative treatment, which was not covered by her policy. The Franklin Health care manager found the resources so the patient could have the treatment she wanted.
The care managers develop a customized treatment plan for each patient, but they try to help the patients reach their personal goals as well.
For instance, the care managers have gotten patients in touch with the Make-a-Wish Foundation, brought family members back from Europe in an end-of-life situation, and found money to pay for flights to treatment centers in other parts of the country for a second opinion. (The health plan pays for second opinions but often not for transportation.)
"We reach out and find resources through their insurance benefits or other sources to help the patients get what they want," Clement says.
The care managers work to find creative solutions to some of the problems they identify. For instance, if a patient needs nutritional supplements and can’t afford them, the care manager can arrange for the patient to get them free through the American Cancer Society.
Seven reasons to hire a temporary case manager
- Respond rapidly to increased caseload, caused by employee vacations, illnesses, and other employee absences.
- Respond to fluctuation in the work force due to terminations, downsizing, or seasonal fluctuations.
- Optimize productivity by reducing caseload to a manageable level, maintaining continuity of care, and covering scheduled time off such as maternity leave and short-term disability leave.
- Manage expenses by decreasing recruiting, training, and benefit costs, avoiding overstaffing, and decreasing employee burnout.
- Acquire specialized case management expertise for temporary situations, such as a catastrophic injury or a case in a rural area you don’t typically cover.
- Save time by leaving the pre-screening and interviewing to the staffing agency.
- Evaluate employee fit and performance before you offer a full-time job.
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