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Hospital case managers routinely face what I call the Bermuda Triangle of case management ethics. The top of the triangle is the clinical concern, encompassing the medical and treatment needs of the patient. On the right are the financial concerns, and on the left are the legal and ethical issues. In the middle of this triangle is the patient.
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Regardless of their practice setting, case managers need to take steps to maintain the confidentiality of protected health information under the Health Insurance Portability and Accountabi-lity Act (HIPAA) of 1996.
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A good working relationship between a knowledgeable and effective case manager and a cooperative, clinically up-to-date physician can result in excellent, cost-effective patient care with superior outcomes and high levels of patient satisfaction.
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Clinicians at PacifiCare Behavioral Health use a variety of techniques to identify patients who may be at risk for suicide, beginning with a members first call to the managed behavioral health plans behavioral health line, which is staffed by customer service associates trained to identify members who need immediate interventions.
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When a case manager for Presbyterian Health Plan couldn't get in touch with a family with two young children with serious health problems, she packed a lunch, charged up her cell phone, drove to the small New Mexico town on the Mexican border where she thought the family lived, and went door-to-door looking for them.
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Case managers who live and work in rural areas often face challenges their big-city counterparts never encounter.
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Even if you're not a designated disease management case manager, you can help your clients manage their chronic diseases, according to Carole M. Stolte-Upman, RN, MA, CCM, CRC, CDMS, CPC, director of Chesapeake Disability Management Inc., a disability case management company in Towson, MD.
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When Philip Bonaparte, MD, joined Horizon Mercy as chief medical officer, his vision was for the health plan to be a partner with the local health care providers.
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The Centers for Disease Control and Prevention (CDC) has issued infection control guidance for managing people in the health care setting and community who may be infected with the monkeypox virus.
