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At least 397 records · Page 22Linked to original sources

PubMed2002

Using case management to increase antiinflammatory medication use among a managed care population with asthma.

The National Heart, Lung, and Blood Institute (NHLBI) recommends the regular use of antiinflammatory medications to achieve and maintain control of persistent asthma, while recommending that quick-relief beta2-agonist medications should be used to treat acute symptoms and exacerbations. Despite these suggestions, the overuse of short-acting quick-relief medications and underuse of long-acting antiinflammatory medications persists. ConnectiCare, Inc., a regional managed care company, used pharmacy claims data to identify members who had been dispensed a total of three or more beta2-agonist prescriptions for three consecutive months in a 12-month period. These members had also not been prescribed an inhaled corticosteroid, cromolyn sodium, or nedocromil during the same three consecutive months. An intensive case management intervention was developed that included multiple contacts from a nurse case manager to provide education and information about asthma control and the guidelines. Twenty-eight percent (n = 40) were purposively chosen to receive the intensive multiple-contact intervention and the remainder received a standard, single-contact intervention. After adjusting for the effects of age, gender, and pre-intervention medication use, ConnectiCare members who received the intensive intervention were 4.3 times more likely to increase the number of antiinflammatory medication prescriptions dispensed that those who received a standard intervention (p < 0.001). This study suggests that the use of intensive case management for persons identified as inappropriate users of asthma medication may result in medication changes that achieve the long-term control of asthma.

Adrenergic beta-Agonists↗

PubMed2003

Improving cancer care in a Kentucky managed care plan: a case study of cancer disease management.

CHA Health (CHA) is a provider-owned managed care plan serving a predominantly rural membership in Kentucky. Quality Oncology, Inc. is a national disease management company specializing in cancer care. This paper reports the results over the first 2 years of a cancer disease management program installed at CHA. The authors also review the evidence-based health services research that has guided the development and implementation of the program. The authors conclude that cancer is a disease state where specialized management can improve efficiency, treatment effectiveness, patient coordination, and outcomes reporting.

Disease Management↗

PubMed2006

Differences in self-management behaviors and use of preventive services among diabetes management enrollees by race and ethnicity.

We assessed the degree that managed care organization (MCO) enrollees used preventive services and engaged in diabetes self-management behaviors by race/ethnicity. A 40-item selfadministered survey was mailed to 19,483 diabetic MCO enrollees. The survey measured use of eight preventive services and engagement in four self-management behaviors among enrollees who self-identified as black, white, or Hispanic. Of the 6,035 surveys analyzed, 4,623 respondents (76.6%) were white, 984 (16.3%) were black, and 428 (7.0%) were Hispanic. Black and Hispanic respondents reported more healthcare visits (mean of 7.0 and 6.5, respectively) in the past year compared to whites (mean, 5.7; p < 0.0001). However, compared to whites, blacks had significantly lower utilization of five of the eight preventive services measured, and Hispanics had significantly lower utilization of seven of the eight preventive services (p < 0.005). With regard to self-management behaviors, blacks were significantly less likely than whites to monitor their diet (65.9% vs. 73.7%, p < 0.0001), exercise (46.4% vs. 52.8%; p = 0.0004) and not smoke (85.1% vs. 89.3%; p = 0.0002); while Hispanics were less likely to monitor their diet (67.3% vs. 73.7%, p = 0.0051). All racial/ethnic groups had low levels of selfmanagement behaviors. Further research is warranted to identify why disparities remain in settings where services are universally available, and to find practical ways to eliminate disparities in a group with routine healthcare encounters.

Black or African American↗

PubMed1999

Case management and the cost of care in the last month of life: evidence from one managed care setting.

Elderly, functionally disabled enrollees in a managed care organization were randomly assigned to case management or regular care. The service use and cost of care for the last month life for the case managed deceased is compared with that of the regular care group. The results suggest that contrary to general expectation, the managed care clients experienced greater use and costs of care in the last month of life.

Activities of Daily Living↗

PubMed2001

Community case management for frail, elderly clients: the nurse case manager's role.

Capitated payment systems have forced healthcare providers to explore new methods of care delivery for frail, older clients who consume a disproportionate amount of time and resources. The authors describe the experiences of frail elders in a community case management program within a managed care setting. The experiences of living with frailty in a changing healthcare system, and perceptions of the case manager's ability to help navigate that system, are described. This article presents the benefits of community case management toward client goals of safety, support, and control.

Aged↗

PubMedDate not supplied

Pediatric care management in a managed care environment: determining the cost of care coordination.

A system of specialty pediatric care management requires an understanding of how medical management and care coordination integrate. This article describes an assessment process undertaken in a specialty pediatric medical center to determine the scope and cost of care management for specific diagnostic groups. The results of this assessment demonstrated the cost of care coordination and the influence of medical severity and psychosocial factors on cost. Replicating the case type assessment approach with clinical care teams expands the understanding of care management functions and helps teams embrace the concepts of severity of illness and complexity of care coordination.

Case Management↗

PubMedDate not supplied

A disease management program for heart failure: collaboration between a home care agency and a care management organization.

This article describes a collaborative approach to manage patients with heart failure between a home care agency and a care management agency. The resulting disease management program used a combination of home visits and phone contact. Care management plans emphasized patient education on increasing adherence to medical and diet regimens, and recognizing early symptoms of exacerbation that could lead to rehospitalization. Clinician activities and patient outcomes are described.

Case Management↗

PubMedDate not supplied

Case management: a strategy for resource management.

Many hospitals and integrated health networks are turning to case management as a means to control costs by more effectively managing resource utilization. The problem arises when an organization does not define the scope of case management or does not identify criteria specific to the needs of the organization and the population it serves. Integrating case management into the existing organizational structure and systems is key to its success.

Case Management↗

PubMed1997

Managed behavioral health care premises, accountable systems of care, and AMBHA'S perms. American Managed Behavioral Healthcare Association.

This article discusses the concepts and approaches underlying managed behavioral health care and the need to assess quality of care. The author describes the Performance Measures for Managed Behavioral Healthcare Programs (PERMS) developed by the American Managed Behavioral Healthcare Association (AMBHA), which is offered as a first step toward enhanced quality of care assessment in managed behavioral health care.

Behavioral Medicine↗

PubMedDate not supplied

Trends in managed care and managed competition, 1993-1997.

According to the recent literature, we are experiencing a managed care "revolution," and managed competition is increasingly being embraced by private- and public-sector policymakers. Using two large employer health insurance surveys, this paper presents new estimates that both confirm and add to our understanding of changes taking place in employment-based health plans. The dramatic shifts in enrollment from indemnity to managed care largely reflect employers' choices about the types of plans to offer. Employees are limited in the number and types of plans from which they can choose. When choice is available, it is generally not governed by managed competition principles.

Costs and Cost Analysis↗

PubMed1991

Use of database management software in a management information system.

If information is to play a useful role in the decision making process, an organization must design a system for capturing, organizing and presenting information from daily activities to its managers. Use of relational database management software to design a custom application as part of a management information system is both practical and cost effective. Designing a database management application is very challenging but well worth the effort, asserts the author of this case study.

Data Display↗

PubMed1995

Materiel managers: survival under managed care.

Managed care by healthcare providers is becoming the method of choice for controlling costs. Insurance companies, employers, employees as well as healthcare providers are all doing what they can to understand and practice economical managed care. With financial systems that reimburse healthcare providers now moving to a capitated approach, providers need to get away from a cost-plus mentality. More than ever materiel managers need to realize that providers are moving from revenue to expense accounting. Under capitation many, if not all, of management philosophy must change to compete in the new healthcare delivery environment.

Capitation Fee↗

PubMedDate not supplied

Improving pain management practice. A medical center moves beyond education to document and manage patient care.

In 1993 nurses at Providence/ Portland Medical Center, Portland, OR, initiated a quality improvement project to assess pain levels in the facility's inpatients. A convenience sample in April 1993 showed an average pain intensity of 6.30 on a 0-10 scale (where O equals no pain and 10 is the worst pain imaginable). With the nursing administrator's support, pain management nurses presented a four-hour course in the basics of pain assessment and intervention to more than 850 nurses and 100 other professionals. In August 1993 nurses found that the intensity of patient pain had dropped to 5.70 on the 0-10 scale. Still dissatisfied with this situation, the nurses proceeded with a three-pronged approach to improve the medical center's quality of pain management: making the problem visible by better documentation and communication about pain; making an institutional commitment to pain management, including establishing pain management quality improvement as the medical center's first patient outcome institutional objective; eliciting the endorsement of influential committees. In August 1994 a random sample revealed patient pain had decreased to 3.21. The next step focused on empowering patients and families through education (e.g., revising the booklet on patient rights and responsibilities, posting signs in rooms encouraging patients to report pain) and clearing up myths and misconceptions through inservices and posters. A sampling in November 1995 showed that the average pain intensity of inpatients had been reduced to 2.32. Plans for continuous quality improvement interventions will further enhance patient comfort and recovery.

Clinical Nursing Research↗

PubMedDate not supplied

Managing managed care.

Managed care creates several dilemmas for the physician executive. Effective management is hindered by lack of analytical tools that stem from current limitations in outcomes research and treatment protocols, altered financial incentives that are controversial and that seem at odds with traditional incentives, and values that create conflict between the needs and expectations of individual patients and populations or groups under managed care. The executive must manage a process that resolves apparent conflict in an explicit ethical framework that acknowledges the limitations of data, with full awareness of the potential conflict between financial incentives and clinical judgement.

Conflict of Interest↗

PubMed2001

Defining the parameters of case management in a managed care setting.

The authors explore how case management evolved from utilization review in order to address the lack of flexibility of basic utilization review. They examine case management's widely diverse state regulatory oversight as well as its lack of a clear definition. The authors then suggest three mechanisms that might be used to devise a universal definition of case management. For the purposes of this article, the authors use the term case management in connection with health benefits plans.

Accreditation↗

PubMed2001

Improvements in diabetes management and outcomes in a Medicaid managed care system.

OBJECTIVE: To determine the impact of managed care on effectiveness of diabetes management in Tennessee, where a statewide Medicaid program (TennCare) delivers services through capitated managed care organizations (MCOs). RESEARCH DESIGN AND METHODS: This retrospective cohort study documented the health care utilization experiences and clinical outcomes of a convenience sample of Tennessee Medicaid enrollees with chronic diabetes before and after the initiation of TennCare. Exposures to recommended diabetic services and outcomes were compared before and after TennCare for 171 enrollees with diabetes in the state's largest academic MCO who met age, continuous enrollment, insurance, and diagnostic criteria for two years before (1992 and 1993) and two years after TennCare (1995 and 1996). Claims data were used to assess baseline characteristics and chart review data were used to assess health services utilization for 71% of cohort members (n = 121) for whom complete medical records were available. The paired t-test was used to compare exposures and outcomes before and after TennCare. RESULTS: Participants had an average of 6.4 outpatient clinic visits per year before TennCare vs. 8.2 visits per year after TennCare (P = .0009), 0.6 vs. 1.0 diabetic eye examinations (P = .0042), 0.2 vs. 0.5 foot examinations (P = .0358), 0.4 vs. 0.6 cholesterol assessments (P < .0001), and 0.5 vs. 1.0 glycosylated hemoglobin assessments annually (P < .0001). Average glycosylated hemoglobin decreased from 10.3 to 8.2 (P < .0001). Although hospitalizations and hospital days increased overall, there was no increase in emergency visits, preventable emergency visits, or preventable hospitalizations. CONCLUSIONS: Enrollees with diabetes experienced increases in utilization of recommended health services and improved glucose control following the initiation of Medicaid managed care. These improvements may reflect improved chronic disease care in a primary care gatekeeper system.

Adult↗

PubMed2002

Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.

BACKGROUND: Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations. OBJECTIVE: To better characterize the range of users of DM in healthcare and to identify critical issues, both present and future, for DM. STUDY DESIGN: Qualitative survey. PARTICIPANTS AND METHODS: Forty-seven healthcare systems (n = 22) and managed care organizations (n = 25) were randomly selected. Decision makers were identified and interviewed between January 1, 2000, and March 31, 2000. We limited quantitative analysis to tabulations of suitable responses, without statistical testing. Responses were organized around 3 themes: models for DM, implementation strategies, and measurements of success. RESULTS: Of 47 decision makers surveyed, 42 (89%) reported that their organizations currently have (75%) or are working to develop (14%) DM programs. Although the goals of DM programs were similar, organizations took a variety of approaches to achieving these ends. There were typically 3 steps in implementing a DM program: analysis of patient data, external analysis, and organizational analysis. Decision makers believed that DM programs had only achieved partial success in reaching the 2 main goals of improved quality of care and cost savings. CONCLUSIONS: Given the variety of DM programs, there is a need to develop a classification scheme to allow for better comparison between programs. Further quantitative studies of decision makers' opinions would be helpful in developing programs and in designing necessary studies of patient management strategies.

Decision Making, Organizational↗

PubMed2004

Advances in migraine management: implications for managed care organizations.

Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has been shown that early treatment with triptans in select patients can improve treatment outcomes. Triptans are selective 5-HT receptor agonists that are specific and effective treatments in the management of migraine, and they meet the acute treatment goal of rapid relief with minimal side effects. Triptans are associated with improved quality of life. Factors such as speed of onset, need for a second triptan dose, and patient satisfaction should be considered in the selection of a specific triptan treatment. Appropriate treatment can decrease costs. The patient's migraine history and response to prior therapy should be considered when selecting acute treatment. Cost-effectiveness models can be used to understand the effect of treatment choices on health care budgets. The direct cost per migraine episode, driven primarily by the need for rescue medications, is important to include in economic models. All aspects of effectiveness (efficacy, tolerability, and cost) should be considered to reduce overall managed care expenditures for migraine treatment. The improved clinical profiles of the triptans provide substantial value to managed care organizations.

Cost-Benefit Analysis↗