Tips from our featured course
Abuse: Member's Care Coordination Calls for Longitudinal
One of the goals replacing the current fragmented fee-for-service care delivery system with the ACO model is to reduce fragmentation and improve communication by having a full-spectrum of care delivery venues and providers whose clinical and financial incentives are aligned.
This will facilitate care coordination and transitions of care. Ultimately, although there is no universally established model, an individual CM may follow a patient along the spectrum of care.
This differs from the more common system currently in place where CMs coordinate care with other CMs across each level of care. A term which might be applied to an individual CM focusing along the entire spectrum of care is longitudinal case management.
[Abuse, Module F, Case Manager's Role]
Population Health: Make Sure Patient has a Safety Net
For those uninsured individuals and those with insurance but having trouble accessing care, safety-net clinics will hopefully remain within the communities that need them most.
Referrals to safety-net clinics should be part of the Case Manager's arsenal to:
- Reduce over utilization of EDs
- Improve the continuum of post-hospitalization quality of care
- Reduce the likelihood of readmission
- Improve the health of the population
Safety-net clinics are also reaching out to qualified health plans (QHPs) and Medicaid Managed Care Organizations (MCOs) to contract with them to accept these insured patients that are having trouble accessing care.
[Population Health, Module A, Care Management]