MCO develops case management guidelines
Aetna Health Plans (AHP) in Middletown, CT, in cooperation with the Individual Case Management Association in Little Rock, AR, released practice guidelines for use by payer-based case managers.
The practice guidelines are designed to help case managers:
* promote consistency within the practice;
* serve as a teaching tool;
* help case managers focus on patient outcomes.
The guidelines will help define the practice and scope of case management, and ensure its valuable role in health care delivery, says Margaret St. Coeur, an AHP nurse and case manager, and primary author of the guidelines.
Topics are presented in the same manner a case manager would would use them during an assessment and primary diagnosis, adds St. Coeur. The guidelines then walk case managers through a series of issues and considerations. Guidelines take a disease management approach to address the entire care continuum, rather than an episodic approach, explains St. Coeur.
In addition to generic guidelines for most diseases, St. Coeur created specific guidelines for high-cost cases, such as HIV/AIDS, high-risk pregnancy, organ transplants, brain injury, and spinal cord injury.
AHP is conducting a pilot case management model incorporating the guidelines in six sites. Patient outcomes will be measured on clinical and financial data, as well as patient and provider satisfaction.
[Editor's note: Copies of the case management practice guidelines can be ordered from Mosby-Year Book's customer service department. Telephone: (800) 633-6699.] *
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