Centers for Medicare and Medicaid Services (CMS)
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Case Managers Are Aging, But Who Will Take Their Place?
Hospital case managers are being asked to take on a bigger, more important role — but, in many cases, staff is not increasing, leading to high caseloads, low morale, and burnout.
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Medical Home Within ED Serves Needs of Sparsely Populated Region
There is ample evidence suggesting new solutions are needed in the way healthcare is delivered in rural America. Multiple factors likely play a role, including the fact that there is a significant shortage of both emergency and primary care providers in rural areas.
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Federal Report Calls for Action to Improve Healthcare Access for Mentally Ill
The Interdepartmental Serious Mental Illness Coordinating Committee released a report to Congress on Dec. 13, 2017, titled, “The Way Forward: Federal Action for a System That Works for All People Living with SMI and SED and Their Families and Caregivers.”
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Using Care Coordination Services, a Health Network Saves CMS More Than $73 Million
Since its first performance year in 2014, one Texas accountable care network has maintained a 95% or better quality score and saved CMS more than $73 million.
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Physician-owned Medical Group Reduces Readmission Rate to 6%
A new population health management program in Ohio is expanding to transform care for Medicare Advantage patients. It’s building on its success with providing a toolbox of services to patients, centered around primary care.
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Housing Is Critical to Healthcare Plan Success
Case management often focuses on patients’ social determinants of health as a part of the bigger health picture. Now, there’s a small but growing number of organizations that are making one social determinant — housing — an integral part of all healthcare coordination.
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Hospital Standardizes Debriefing After Critical Events
The maternal and fetal medicine team at Sharp Grossmont Women’s Health Center, affiliated with Sharp Grossmont Hospital in La Mesa, CA, improved quality of care recently by implementing a standardized debriefing process for critical events.
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Patients Threatened by Gaps in Care When They Change Settings
Patient safety and quality of care are threatened when patients move from one setting to another, but there are strategies that can address those gaps in care.
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Revenue Cycle Team Optimizes Reimbursement
If a hospital doesn’t have a revenue cycle management committee, case managers can approach leadership and suggest that they propose that the hospital administration create a committee to review all contracts and denials.
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Large Caseloads Make Denial Prevention Difficult
Hospitals that pile task after task on case managers and assign them large caseloads are unlikely to effectively manage denials.