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BlueHealthConnections, a care management program in use at Blue Cross Blue Shield of Michigan in Detroit, pulls together a lot of care management programs that have been in place for many years.
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When Horizon/Mercy compiled the six-month outcomes report for its program to reduce the level of lead in its young members blood, the figures were so astonishing that the state epidemiologist monitoring the program checked them himself.
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Before Trenton, NJ-based Horizon/Mercy started its Childrens Health Assessment, Maintenance, and Preventative Services (CHAMPS) program for publicly insured mothers with infants, many of the mothers didnt realize the importance of getting immunizations and well-child visits for their children, says Giavanna Ernandes, RN, MSN, APNC, team leader for disease management, including the CHAMPS program.
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When it comes to confidentiality issues, case managers often walk a tightrope, Mindy Owen, RN, CRRN, CCM, asserts.
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When youre confronted with an issue that just doesnt feel right, ask yourself: Am I truly doing the right thing at the right time for the right reason?
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If youre a typical case manager, you are faced with ethical dilemmas several times a day. The job is pressure-filled. Case managers are under pressure from insurers to contain costs, from employers to return people to work.
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Sixty percent of physicians responding to a survey by the Pennsylvania Medical Society expressed frustration with eroding patient-doctor relationships and blame lack of time
for the problem.
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Thanks to BlueHealthConnection, a new integrated care management program, more than a million members with coverage through Blue Cross Blue Shield of Michigan have just one source for answers about their health care needs.
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In the first four months, Horizon/Mercys sickle cell disease management had identified 111 members with sickle cell and started an education program to help them avoid a painful crisis and hospital admissions.
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A series of case management initiatives to improve the health of their publicly insured young populations has paid off for Horizon/ Mercy.