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Everyone knows that inconsistencies in health care can adversely affect patient outcomes, waste time and resources, and ultimately cost the consumer, the provider, and the health plan money.
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Some insurance companies often use surveillance techniques in an attempt to discover fraud in workers compensation and disability cases. When cameras are brought in, case managers should step out in order to avoid ethical dilemmas. But clearly this is easier said than done.
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Dietary counseling can be beneficial for adults with high cholesterol and other risk factors for diet-related chronic disease such as high blood pressure and obesity, the U.S. Preventive Services Task Force has recommended.
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When members call the Blue Shield of California Lifepath Adviserssm line, they can get answers to health and wellness questions from a registered nurse, speak to a mental health counselor, or consult with a specialist on everything from childcare to legal and financial questions.
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No matter which Lifepath Adviserssm service Blue Shield of California members choose, they get a comprehensive assessment and a plan of care to help them deal with their problems.
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Member satisfaction surveys give health plans a chance to hear the voice of the customer, says Terri Cox Glassen, RN, MN, assistant vice president of consumer satisfaction for CIGNA HealthCare with headquarters in Bloomfield, CT.
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In just six months of operation, the congestive heart failure disease management program at Horizon/Mercy has resulted in few hospital admissions for some patients.
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To get, on their own, the information that Pittsburgh-based Highmark Blue Cross Blue Shields SMART Registry provides them, physicians would have to conduct extensive and time-consuming chart reviews.
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Highmark Blue Cross Blue Shield combined its previously disjointed disease management programs into an integrated condition management program that focuses on reducing the variations in effective care for five common conditions.
