Centers for Medicare and Medicaid Services (CMS)
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How to Fight Denials
Case managers do not have to settle for denials. In fact, they can use their skills to overturn denials. There are certain tactics that can help in this process, and some case management professionals even specialize in this.
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Hispanic Patients with Diabetes Need Better Care Transition Models
About one in 10 Americans are diagnosed with diabetes, and the Hispanic/Latino population is disproportionately affected. Their risk is higher — and their outcomes are worse — than the white, non-Hispanic population. Researchers designed a transition of care model and pilot to see if they could improve outcomes.
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Care Transitions Through ACHIEVE Study Score Points with Patients
Care transitions across organizations and the community require better collaboration and communication among providers and social service organizations, according to recent research. Patients benefited from improved collaboration. They reported feeling better supported and cared for by providers involved in a care transition project.
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Patients with Parkinson’s Disease Often Lost to Follow-Up Care
Telehealth visits can improve continuity of care, quality of life, and overall health for patients with Parkinson’s disease, recent research shows. Although Parkinson’s affects 1.2 million people in the United States, there is little research on people in later stages of the disease.
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Detailed Resource Tools for Care Coordinators and Case Managers
Case managers and care coordinators need such a wide range of knowledge about community resources to address their patients’ social determinants of health that resource tools can be a huge time-saver. For a care coordination program involving complex pediatric patients, leaders developed a series of nearly two dozen resource guides they call playbooks.
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Inside the Indiana Complex Care Coordination Collaborative
Indiana’s Medicaid program administrators found value in embedding nurse care coordinators in primary care practices to address social determinants of health and transitional care issues in a population of children with complex medical issues.
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Indiana Medicaid Officials Embrace Care Coordination Project
A project to improve care coordination for children with complex medical needs revealed well-trained nurse care coordinators could manage a 100-patient caseload and improve outcomes. Nurse care coordinators were embedded in primary care provider offices and were trained to provide care coordination, including helping patients with medical and social needs.
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Better Care Communication Needed for Home Health
Researchers wanted to know if there is an association between home health and gaps in care coordination among providers. They found patients receiving home healthcare are sicker, experienced more functional dependencies, and reported more preventable drug-drug interactions. While home health was not associated with a difference in gaps of care coordination, it was associated with twice the risk of a preventable adverse outcome.
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Many Safety Net, Rural Hospitals Do Not Properly Address Social Needs
Safety net hospitals, critical care hospitals, and rural hospitals often do less than needed to address the social determinants of health of their vulnerable populations, particularly during the COVID-19 pandemic, new research shows.
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Better Care Coordination Needed for Interhospital Transfers
Interhospital transfers can be challenging and frustrating for nursing staff — and sometimes dangerous and tragic for patients and their families. Health systems should pay more attention to how these transfers are handled and work to improve communication between sending and receiving hospitals.