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As employers look at ways to deal with escalating health care costs, case managers likely will find themselves playing key roles. They will not, however, be the only ones in the game. Case managers complement disease managers as the two roles become integrated for more powerful care coordination.
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As part of its efforts to promote preventive care and appropriate management of chronic diseases, Blue Cross and Blue Shield of Florida has begun the Recognizing Physician Excellence (RPE) program, which will reward physicians based on several criteria, including patient satisfaction, clinical quality and efficiency, and administrative efficiency.
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A Harvard Medical School study has found that current practice management strategies and financial arrangements have a limited impact on the quality of care for patients with diabetes.
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For as long as humans have been taking care of other humans who are sick or hurt, the rendering of solace and physical comfort has been the core from which all other types of aid have grown. But a nurse and ethicist in California says that ignoring the value of giving of solace and comfort amounts to turning away from the prime reason for the practice of medicine.
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It is a well-known fact in the health care community that there are diabetes disparities among ethnic groups. Diabetes is a problem throughout the United States. An estimated 18 million people suffer from the chronic disease, and people of color are more likely to develop Type 2 diabetes.
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An intensive face-to-face care management program for severely ill Medicare patients with advanced congestive heart failure and/or complex diabetes has paid off for XLHealth, a Baltimore-based disease management firm. The company has reduced spending by as much as 26% after 24 months of intervention for private HMO patients and has reduced lower limb amputations by more than 60%.
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Case managers with the Hawaii Medical Service Association (HMSA), a nonprofit medical indemnity association, follow a practice model that differs significantly from that used at most other insurance companies, says Melissa Bojorquez, ACBSW, MBA, CCM, supervisor for the HMSA case management program.
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The movement to prevent wrong-site or wrong-person surgery got another boost recently when a major health plan announced affective Jan. 1, 2005, it will no longer pay for medical procedures involving those egregious errors. Dont expect to get paid for a procedure if you leave that 12-inch retractor in the patients belly, or the next procedure to remove it.
