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As employers look at ways to deal with escalating health care costs, case managers likely will find themselves playing key roles. They will not, however, be the only ones in the game. Case managers complement disease managers as the two roles become integrated for more powerful care coordination.
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Although the most common reasons for hospitalization among HIV patients in six hospitals nationwide are for comorbidities, there remains a significant rate of hospitalization for opportunistic infections (OIs), a new study says.
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People who are publicly insured need more advocacy than other populations, and the problems they face negotiating the health care system can be compounded when they dont understand the language, points out Pamela Persichilli, RNC, director of clinical operations for Horizon NJ Health, a Trenton, NJ-based managed care organization for the publicly insured.
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Nearly half of all American adults 90 million people have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with such limited health literacy, states a report released April 8 by the Institute of Medicine (IOM).
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As employers contract with multiple vendors to get best-in-class health care services, an employee may have a medical plan managed by a managed care organization, disease management programs handled by a number of specialty vendors, and a pharmacy plan managed by another company. Thats one of the reasons why CIGNA HealthCare began its Health Advisor Program in January as a way to assist employees and their families in navigating the health care system.
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Its not unusual for a care manager in Horizon NJ, Healths Care Coordination Unit (CCU) to get a thank-you note or a telephone call from a member or their relative enrolled in the managed care organizations program for publicly insured members with special needs.
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A sophisticated technology system helps the 2,400 case managers at Intracorp coordinate the care of nearly 2 million people each year and helps the company track outcomes information.
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In a quest to meet the growing need for disease management programs to demonstrate their effectiveness, a group of industry stakeholders has come up with a set of processes that can be used to show the outcomes of disease management.
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When Steve Dawson, PT, was first approached with the idea of teletherapy four years ago, he had to laugh. Providing therapy services over a videophone to a patient in a remote location went against the very grain of his profession.
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A program in which case managers coordinate the care of members with complex medical conditions and those who are at high risk for chronic diseases has paid off for Care Choices HMO of Farmington Hills, MI.
