-
Targeting the right members for intensive disease management is the key to a successful program, says Christobel E. Selecky.
-
When Blue Cross and Blue Shield of Missouri negotiated a contract with Quality Oncology to handle utilization management and case management services care for its members with cancer, the health plan insisted that the vendor use the insurers system so the in-house staff would have instant access to patient data.
-
When the quality management and quality improvement teams at Blue Cross and Blue Shield of Missouri examined the data for each disease, they found that the costs for oncology were increasing at a much greater rate than for other diagnoses and that the increases were exceeding 10% a year.
-
Youre a case manager for an insurance company, and a spinal cord injury case that needs intensive management and care over a long period of time lands on your desk. Youve never handled care for a spinal cord injury patient. Where do you turn for help?
-
Griffin Hospital in Derby, CT, routinely gets a 97% to 100% patient satisfaction rating on a monthly telephone survey of about 15% of discharged patients. More than 80% of patients say they are willing to return to Griffin Hospital and would recommend the services to their family and friends.
-
At Griffin Hospital in Derby, CT, the patients care is managed by their primary care nurse, their case manager, and by the patients themselves. As a result, the nonprofit hospitals lengths of stay are at or below the averages reported by the Centers for Medicare & Medicaid Services.
-
The approximately 4,000 indigent patients in the University of Iowa Hospital and Clinics Care Management program (CMPUI) in Iowa City make up 3% of patients but utilize 6.5% of hospital resources and represent 6.4% of acute admissions.
-
A multidisciplinary program staffed by nurse practitioner case managers and social workers has resulted in dramatic decreases in admissions, lengths of stay, and emergency department visits among indigent patients cared for at the University of Iowa Hospitals and Clinics in Iowa City.
-
Case managers are no strangers to quality improvement (QI) tools; for many years they have used a number of QI tools to improve processes and to help them meet accreditation standards.
-
These are the Commission on Accreditation of Rehabilitation Facilities (CARF) standards (copyrighted by CARF in the 2003 standards manuals) that are new for every type of facility:
