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In April 2002, Donna Zazworsky, MS, RN, CCM, FAAN, director of grants, partnerships, and policy at St. Elizabeth of Hungary Clinic in Tucson, AZ, got a telephone call from a case manager at a local hospital who wanted to know if the clinic had a hospital bed it could donate for use by a 17-year-old patient who was being discharged.
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The trauma team at Borgess Medical Center in Kalamazoo, MI, refers to Dorothy Malcolm, RN, BSN, as the glue that holds us all together. As trauma case manager, Malcolm coordinates care for trauma patients from the time they come into the emergency department (ED), during their entire stay in the hospital and while they are being treated in the outpatient follow-up clinics.
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Merging the case management department with the quality department is the best thing weve ever done, says Sharon Simmons, CRNP, MSN, CNOR, director of clinical excellence for St. Vincents Hospital in Birmingham, AL. Combining the departments has resulted in a tremendous improvement in quality of care as well as improved outcomes, she adds.
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With less than a year left before the HIPAA Security Rule goes into effect, a study by URAC has shown that the majority of health plans are not prepared.
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An automated calling system reminding members to get preventive health care services has paid off for Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Instead of receiving a postcard reminding them to go for immunizations, cancer screenings, prenatal and postnatal care, and other preventive health care services, members who are eligible for the services receive a computer-generated telephone call.
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A system that rates cases by acuity level helps case managers at BlueCross and BlueShield of Oklahoma (BCBSOK) keep their workload evenly distributed. Cases are stratified by complexity, with Level 1 being the lowest acuity and Level 5 the highest.
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A system to help identify patients who are at risk for suicide, chemical dependency, or premature treatment termination is a great adjunct to traditional psychiatric care, asserts Daryl E. Quick, PhD. Quicks organization, Western Psychological and Counseling Services, uses the ALERT Predictive Modeling and Outcomes Management System from PacifiCare Behavioral Health.
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When QMed contracts with a health plan to manage its coronary artery disease, heart failure, or diabetes population, the Laurence Harbor, NJ, disease management firm does more than just rely on claims data to come up with a treatment plan for members identified for disease management. The company also sends a team of specialists into individual physician offices to extract data from the patient files of members identified for the program, often coming up with clinical information and medical histories that arent available from the insurance carrier.
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A field-based disease management care program in which nurses meet face to face with members with chronic kidney disease and end-stage renal disease has resulted in dramatic decreases in emergency department (ED) visits and hospital bed days for patients managed by RMS Disease Management Services in Vernon Hills, IL, an affiliate of DaVita Inc.
