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Here are definitions of three types of workers' compensation insurance policies, according to Christine R. Zichello, RN, COHN-S, CSHM, ARM, FAAOHN, senior risk control specialist at PMA Insurance Group's Mount Laurel, NJ, branch office:
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As part of its efforts to promote healthy living and save health care dollars in the long run, Regence BlueCross BlueShield is rewarding members for adapting healthy lifestyles.
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A Medicare demonstration project in Florida that includes both telephonic case management and face-to-face interventions has improved clinical outcomes for beneficiaries who are eligible for both Medicare and Medicaid and have congestive heart failure or any combination of comorbidities that include congestive heart failure, diabetes, and coronary artery disease.
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"People think of insurance as somebody gets hurt, they submit a claim, they get paid, and that's the end of it, but there are all different types of programs," says Christine R. Zichello, RN, COHN-S, CSHM, ARM, FAAOHN, senior risk control specialist at PMA Insurance Group's Mount Laurel, NJ, branch office.
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Getting more involved in workers' comp is your "chance to show cost savings to upper management," says Moniaree Parker Jones, RN, MSN, COHN-S, CCM, formerly a senior occupational health nurse in the Alabama/Mississippi regional office of State Farm Insurance Co.
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Dania Anderson, LCSW, is something like a detective. As an outreach coordinator for Health Integrated, a targeted population health management company, Anderson visits doctors' offices, hospitals, clinics, group homes, soup kitchens, and other community agencies in her quest to locate health plan Medicaid members receiving Supplemental Security Income (SSI) benefits who could benefit from Health Integrated's care coordination programs.
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An approach that incorporates its telephonic integrated health coaching services with health plan case management and other health management programs, community-based resources, and physician practices has paid off for Health Integrated.
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If you are managing the care of a catastrophically ill or injured patient who needs complex care planning, coordination of resources from many sources, and a large allocation of financial resources that could cause the patient to reach his or her maximum lifetime benefit, it could be helpful to you and the patient to find out who may be sharing the risk.
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One key to discharge planning is understanding what might prevent your patient from following medication and other instructions.
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When asking for resources for an occupational health initiative, you need to prepare a realistic program with solid goals and objectives; otherwise, you risk the program failing and your credibility diminished. Avoid these pitfalls:
