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Monday, June 16, 2014
  Clinical Accuracy Spoken Here  

CM Express: Do You Speak
Two Languages?

In order for CMs to effectively participate in the claims and reimbursement process which is the major source of a healthy cash flow, they must "speak the language" of that process.

Reimbursement is associated with terms such as:

  • DRGs
  • Carve-outs
  • Fee-for-service
  • Capitation

The effective CM must speak at least two languages: medical language and the language of reimbursement.

[Reference: CM Express, Module B, Improving Claims]
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  Excellence in Case Mgmt  

CM Express: CMs Improve
HC Delivery

Concerns about costs, quality of care, and patient safety continue to drive efforts to improve utilization of health care resources.

Healthcare will continue to evolve and this evolution may be painfully slow. Case managers can support efforts to achieve changes resulting in a speedier recovery.

The contributions which Case Managers (CMs) and other transdisciplinary team members make in achieving higher quality and more efficient care which optimizes each patient's experience all contribute to global improvements in health care delivery.

[Reference: CM Express, Module C, Effective Resource Management]
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  Improving Patient Care...  

CM Express: Unplanned Care Transitions

Many transitions are unplanned:

  • Resulting from unanticipated medical problems
  • Occurring in 'real time' during nights and on weekends
  • Happening so quickly that the formal and informal support mechanisms cannot respond in a timely manner

Transition of care planning requires evolution to a deliberate, coordinated, synchronized approach to anticipate and implement a much broader plan of needs for the patient.

[Reference: CM Express, Module D, Enhanced Care Transitions]
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Tom RasmussenTom Rasmussen
Publisher
Athena Forum
Tom.Rasmussen@AthenaForum.com

 
 

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Cathy WrightCathy Wright, BSN, RN
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