Case Management Advisor – March 1, 2003
March 1, 2003
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Look to your reinsurer for help in managing catastrophic cases
Youre a case manager for an insurance company, and a spinal cord injury case that needs intensive management and care over a long period of time lands on your desk. Youve never handled care for a spinal cord injury patient. Where do you turn for help? -
What are the uses of reinsurance?
A catastrophic case that involves a lot of coordination of resources, a lot of care planning, and a large allocation of financial resources that may or may not cause the patient to reach his or her maximum lifetime benefit should be a flag to the case manager to find out who may be sharing the risk. -
Oncology CM vendor improves cancer care
When the quality management and quality improvement teams at Blue Cross and Blue Shield of Missouri examined the data for each disease, they found that the costs for oncology were increasing at a much greater rate than for other diagnoses and that the increases were exceeding 10% a year. -
Collaboration: Key to oncology program
When Blue Cross and Blue Shield of Missouri negotiated a contract with Quality Oncology to handle utilization management and case management services care for its members with cancer, the health plan insisted that the vendor use the insurers system so the in-house staff would have instant access to patient data. -
Predictive modeling helps DM company focus on care
Targeting the right members for intensive disease management is the key to a successful program, says Christobel E. Selecky. -
Regular data aid DM effectiveness
When a member of LifeMasters Supported SelfCares disease management program weighs himself, takes his blood pressure, or blood glucose level, he dials a toll-free number, enters his personal code, and follows the computer prompts to enter the data being monitored. It all takes a minute or less. -
Physicians appreciate DM assistance
Christobel E. Selecky actually has had physicians thank her for sending them treatment guidelines along with information about their patients with chronic diseases. -
Program targets diabetics with highest utilization
When it comes to a common disease such as diabetes, we cant manage the universe, Giavanna Ernandes, RN, MSN, APNC, asserts. -
Little things indicate a patient has depression
A patient whose chronic illness you are managing is not likely to tell you that he or she is depressed. -
Reports From the Field: Plan knowledge affects how consumers look at cost of drugs
Consumers drug-buying behavior may be based on how much they know about their personal health care coverage, a Harris Interactive survey reveals. -
Reports From the Field: Musculoskeletal conditions, mental health impact productivity
Musculoskeletal conditions, including arthritis, low-back pain, repetitive motion strain, and mental health problems mostly depression have the biggest negative impact on worker productivity, according to a survey by the Institute for Health and Productivity Management (IHPM), a nonprofit research organization in Scottsdale, AZ. -
Reports From the Field: Physicians report frustration with managed care red tape
Sixty percent of physicians responding to a survey by the Pennsylvania Medical Society expressed frustration with eroding patient-doctor relationships and blame lack of time for the problem. -
Reports From the Field: White paper addresses HIPAA concerns and DM
A comprehensive analysis of the Health Insurance Portability and Accountability Act (HIPAA) and its impact on disease management has concluded that the new privacy regulations will not hamper disease management programs, according to the Disease Management Association of America (DMAA).