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Patients with life-limiting conditions who received patient-centered management had dramatically reduced utilization and cost of care compared to patients with similar conditions who received regular case management, a study by Blue Shield of California has concluded.
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Many top hospital decision makers still fail to recognize that case management is a core function of patient care, not an optional service that needs to prove return on investment, says Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of the Center for Case Management in South Natick, MA.
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When Nancy Skinner, RN, CCM, was diagnosed with lung cancer in 2004, she asked her health plan for a case manager to help her navigate through the health care system during treatment.
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When it comes to coding, a rose by any other name may mean that your hospital isn't getting the reimbursement it deserves.
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Case management involvement in the documentation enhancement process can be limited to monitoring specific DRGs and collaborating closely with coding specialists to an environment where the case management department has staff whose entire focus is on documentation enhancement, asserts Lorraine Larrance, BSN, MHSA, CPHQ, CCM, manager with Pershing Yoakley & Associates, a Charlotte, NC, health care consulting firm.
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More than 800 people have been screened and more than 100 are being treated for previously undiagnosed hypertension thanks to a program sponsored by CareFirst BlueCross BlueShield conducted in barber shops and beauty salons in Baltimore's African-American community.
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An oncology program, launched in January by Cigna HealthCare, provides members with cancer support through diagnosis, treatment, and survival.
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List the components of patient- and family-centered care and many would think it was the formula for good education. The four core concepts include "dignity and respect," "information sharing," "participation," and "collaboration."
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While the rapid growth of hospital-based palliative care programs is the good news, the bad news is the wide range of quality and standards that exist, notes Betty Ferrell, PhD, RN, research scientist at City of Hope National Medical Center in Los Angeles and chair of the National Consensus Project for Quality Palliative Care (NCP) Task Force.
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Bariatric surgery works wonders, but it's not a miracle cure. That's why insurers and hospitals alike take pains to make sure their patients are prepared for the surgery and the lifestyle changes it requires.
