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One of the great challenges in the whole world of quality and patient safety is learning to take advantage of the richness of clinical cases, says Robert M. Wachter, MD, professor and associate chairman in the department of medicine at the University of California, San Francisco (UCSF) and chief of the medical service at UCSF Medical Center.
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A Medicaid disease management program represents a huge potential to improve the health of the publicly insured while decreasing overall health care costs, Sandeep Wadhwa, MD, asserts.
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In the first 12 months of a comprehensive disease management program for members with 17 chronic conditions and diseases, Blue Cross and Blue Shield of Minnesota saved $36 million in claims, with a return-on-investment of $2.90 for every dollar spent.
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If you are a case manager who also is performing disease management activities, keep in mind that the two activities require distinctly different skill sets, suggests Rufus Howe, RN-C, MN.
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For case managers working in an acute-care environment, advocacy is a fundamental principle of the services they provide. Advocacy may be described simply as wanting, getting, and doing what is in the best interest of the patient and the family. In practice, however, case managers find themselves acting as advocates not only for the patient and family but for the hospital and provider of care as well.
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By creating a series of tools and other resources, Premera Blue Cross has been able to increase the efficiency of its case management department and earn coveted accreditation from Washington, DC-based URAC. The case management program at the Mountlake Terrace, WA, health plan is one of only two in the state of Washington to achieve URAC accreditation. The health plan covers members in Washington and Alaska.
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It sounds exciting to be an expert witness until you take the stand in court and the attorney for the other side questions your credibility, B.K. Kizziar asserts. Thats why she advises case managers who are interested in becoming expert witnesses to learn how the legal system works and be prepared for what they may encounter in a case.
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In an effort to ensure that chronically ill members get the most effective and efficient health care services, BlueCross BlueShield of Tennessee has developed a pilot project to pay physicians for e-mail consultations, telephone calls, and group visits with members with diabetes, hypertension, or congestive heart failure.
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Adults with lower than average reading skills are less likely than other Americans to get potentially life-saving screening tests, be vaccinated for flu and pneumonia, and take their children for well-child physician visits, according to a report by the federal Agency for Healthcare Research and Quality (AHRQ).
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Documentation is a valuable communication tool throughout the case management process, providing an accurate record of the assessment, care plan, and execution of treatment and services. Through systematic collection of information about the service experience, the end results of care can be evaluated.
