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As payers and providers alike begin to recognize the value of care coordination, case managers are being given more and more responsibility.
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With surging demand from patients with both medical and mental health needs, and continuing pressure to reduce costs, ED managers have a full plate of concerns to contend with.
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When you meet with patients in person, you can find out information, determine their level of understanding, and develop rapport much better than just talking to them on the telephone, says B.K. Kizziar, RNC, CCM, CLCP, a case management consultant based on Southlake, TX.
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Georgene Siemsen, MS, RN, GNP-BC, visited the home of a 74-year-old patient at Bend (OR) Memorial Clinic because of concerns that she was not refilling her medication consistently. Inside, Siemsen found a disorganized collection of old bottles, expired prescriptions, and multiple refills of the same medications.
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When the Bend Memorial Clinic receptionist offered a 90-year-old patient a brochure describing the clinic's medical home model and a letter introducing the nurse care management program, the patient angrily threw the materials back.
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When patients who have a high risk of rehospitalization are discharged from Bayada Home Health Care's home health services, the Mooretown, NJ, home health company calls them monthly for the next year to find out how they are feeling and whether they need assistance or additional services that will help them avoid another hospital admission.
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As a result of a patient-centered medical home pilot program based around preventive and coordinated care, Bend (OR) Memorial Clinic's hospital admissions and emergency department visits dropped for Medicare Advantage members of PacificSource Health Plans.
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Health care costs for participants in a health and wellness coaching program were $19 to $22 per member per month less than for a control group in a study by an independent researcher conducted for Medica, a health insurance company with headquarters in Minneapolis.
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Providers and insurers are starting to add lifestyle coaching to the range of interventions they provide to help motivate people to take charge of their own health and make changes in the way they live that help them live healthier, more productive lives.
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Based on the positive outcomes of a health coaching pilot for its employees with diabetes, Advocate Health Care, an integrated healthcare system based in Oak Brook, IL, now offers health coaching to its patients, employees, spouses, and employer groups as part of its comprehensive wellness solution.
