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As health insurance costs escalate and employers provide a lower level of coverage for employees or cut out insurance benefits altogether, the number of workers with no health insurance is on the rise. Meanwhile, states are struggling with dwindling funds for Medicaid and are slashing benefits, and an unprecedented number of undocumented workers are seeking care in hospital emergency departments.
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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.
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A predictive modeling program is just the first step in identifying members for a comprehensive disease management program, says Michael Cousins, PhD, manager of health informatics for Health Management Corp. (HMC), based in Richmond, VA.
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Great-West Healthcares disease management approach won the Denver-based company the award of best disease management program in a national PPO for 2002-2003 from the Disease Management Association of America (DMAA).
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If youre not calling on the resources of your companys physician medical directors, you may not be maximizing your resources to optimize patient care.
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When it comes to accepting cash payments from providers in exchange for referrals, there is no question: It is expressly forbidden. But what happens with noncash items, such as the seemingly innocuous gifts that show up around the holidays or the New Year. What are the rules?
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A depression management program has resulted in better scores on Health Plan Employer Data Information Set (HEDIS) measures and a reduction in depression screening scores for Fallon Community Health Plan, with headquarters in Worcester, MA.
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A program in which case managers coordinate the care of members with complex medical conditions and those who are at high risk for chronic diseases has paid off for Care Choices HMO of Farmington Hills, MI.