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When QMed contracts with a health plan to manage its coronary artery disease, heart failure, or diabetes population, the Laurence Harbor, NJ, disease management firm does more than just rely on claims data to come up with a treatment plan for members identified for disease management. The company also sends a team of specialists into individual physician offices to extract data from the patient files of members identified for the program, often coming up with clinical information and medical histories that arent available from the insurance carrier.
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A system to help identify patients who are at risk for suicide, chemical dependency, or premature treatment termination is a great adjunct to traditional psychiatric care, asserts Daryl E. Quick, PhD. Quicks organization, Western Psychological and Counseling Services, uses the ALERT Predictive Modeling and Outcomes Management System from PacifiCare Behavioral Health.
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A system that rates cases by acuity level helps case managers at BlueCross and BlueShield of Oklahoma (BCBSOK) keep their workload evenly distributed. Cases are stratified by complexity, with Level 1 being the lowest acuity and Level 5 the highest.
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An automated calling system reminding members to get preventive health care services has paid off for Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Instead of receiving a postcard reminding them to go for immunizations, cancer screenings, prenatal and postnatal care, and other preventive health care services, members who are eligible for the services receive a computer-generated telephone call.
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With less than a year left before the HIPAA Security Rule goes into effect, a study by URAC has shown that the majority of health plans are not prepared.
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Although the most common reasons for hospitalization among HIV patients in six hospitals nationwide are for comorbidities, there remains a significant rate of hospitalization for opportunistic infections (OIs), a new study says.
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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.
