522 - Profiting from Patient-Centered Care Coordination

Profiting from Patient-Centered Care Coordination

515 - Case Managers in the Primary Care Practice

Case Managers in the Primary Care Practice

Case Studies in Comprehensive Primary Care

This 50-page report gives healthcare organizations a leg up on CPC, starting with an examination of the staffing model from Group Health Cooperative that, in addition to impressive clinical outcomes, has earned the health system a reputation as a "model for healthcare reform."

$137.00
In stock
SKU
516

Like the convenience of an instant PDF download, but still want a hard copy of this book? Order both versions and save 35 percent!

The fact sheet on the Comprehensive Primary Care (CPC) initiative by the Centers for Medicare and Medicaid Services (CMS) points to results from several organizations that "have taken the lead in investing in primary care:"

  • Group Health Cooperative of Puget Sound reduced emergent and urgent care visits by 29 percent and hospital admissions by 6 percent.
  • Geisinger Health Plan reduced admission rates by 18 percent and hospital readmissions by 36 percent per year.

Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System takes a look at the successful patient-centered approaches by these two innovators, sharing key strategies and lessons learned from program implementation.

CMS says its CPC program is modeled after the innovative practices developed by large employers and others in the private sector. Under CPC, Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in CPC will be given resources to better coordinate primary care for their Medicare patients.

This 50-page report gives healthcare organizations a leg up on CPC, starting with an examination of the staffing model from Group Health Cooperative that, in addition to impressive clinical outcomes, has earned the health system a reputation as a "model for healthcare reform."

Michael Erikson, Group Health's vice president of primary care services, walks through the Washington State-based cooperative's primary care practice redesign, retooled staffing models and program rollout tips. Group Health Cooperative was among the top 10 commercial health plans for 2009-2010 as ranked by the NCQA and U.S. News Media Group.

Another model frequently imitated in the industry is Geisinger Health Plan's ProvenHealth Navigator (SM), the plan's home-grown medical home constructed around an embedded case manager.

In ProvenHealth Navigator(SM), Geisinger's home-grown medical home model, case managers are carefully matched with primary care practices, where they help to identify highest-risk patients and develop customized care plans that foster self-management of chronic conditions and more judicious use of healthcare resources.

How does the presence of a case manager in a physician practice affect practice workflows, efficiency, patient health status, health utilization and patient and provider satisfaction? Geisinger Health Plan's Diane Littlewood, RN, BSN, CDE, regional manager of case management for health services, and Joann Sciandra, BSN, CCM, director, case management strategic planning for health services, address these aspects of the approach and more, including:

  • Engaging and incenting physician practices to embed case managers to assist with care transitions and patient compliance;
  • The case manager selection and training process;
  • Identifying populations for case management;
  • Skill sets, roles, tools and responsibilities of the embedded case manager;
  • Case load management;
  • Real-life examples of patient self-management patient action plans;
  • Results from Geisinger's embedded case manager program, including its impact on patient compliance, care transition management, medication adherence, hospital readmissions;
and much more.

More Information
Author HIN
Book No
Write Your Own Review
Only registered users can write reviews. Please Sign in or create an account