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When members call a nurse triage line about a health problem, theyre at a teachable moment when they are receptive to taking action about their conditions, Kevin Maher, RN says.
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Todays case managers need to understand outcomes and track them in order to prove that their interventions have value, says Mary Jane McKendry, RN, CCM, MBA, director of education, training and consulting for McKesson and is president-elect of the Case Management Society of New England in Hampstead, NH.
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Before you start your outcomes measuring program, you need to decide what youre going to track and how youre going to document your savings.
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Case manager interventions can benefit patients who are dealing with chronic conditions, a member of an advisory board working to improve health care says.
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When members enroll in one of Health Alliance Plans (HAP) disease management programs, the health assessment questionnaire they fill out includes trigger questions that may indicate that the member is at risk for depression.
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If you work for an HMO with a computer system that tracks patient data, you may be able to take advantage of a research organizations expertise to help you develop programs to better manage your patients.
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Patients with psychological disorders who have been prescribed anti-psychotic drugs, such as mood stabilizers, may really want to take their medication as prescribed but need a lot of help to do so, asserts Dawn Velligan, PhD, associate professor at the department of psychiatry at the University of Texas Health Science Center at San Antonio.
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When a CIGNA member is hospitalized in Tampa Bay, FL, he or she is likely to get a visit in the hospital from Joy Bazo, RN, CMC, LHRN, on-site review nurse for CIGNA in the Tampa Bay area.
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Its disturbing to Mindy Owen, RN, CRN, CCM, when she encounters someone who calls him- or herself a case manager but whose job description doesnt sound like case management at all.
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Regions of the United States where more health care is delivered dont provide better care than regions with more conservative practice patterns, according to studies by researchers at Dartmouth Medical School and the Veteran Affairs Medical Center in White River Junction, VT.
