Provider and member satisfaction is key when discussing desired outcomes of embedded case management practices, particularly from a regulatory viewpoint, says Charlene Schlude, RN, CCM, director of case management at Capital District Physicians Health Plan (CDPHP). Evaluating the medical cost trends of embedded versus telephonic case managers is also essential for establishing their viability.
An important question is identifying the outcomes we are looking for. We are not at the point to show dollars per savings, but that is the direction we are going in. We are evaluating the quality and efficiency metrics for each practice to see if there is improvement. We have several embedded practices, and we have others where there are no embedded services. We are going to be looking at those practices that don’t have case management and the ones that do to see if there is a difference in medical trend. We want to see if there is a difference between the embedded model and the telephonic model because we know that that engagement is much higher when you see a patient in the practice, and if someone engages in case management, they are more inclined to follow the directions and get involved with a plan of care.
We have planned to try to determine an ROI methodology, and we are going to be using independent consultants for that in 2012. We are also going continue to look at provider and member satisfaction. That is very important for us from our regulatory entities. NCQA feels that member satisfaction is key, and we continue to look at that.
Source: Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination
Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination
examines two promising pilots in embedded case management: Nurse Navigators working alongside physicians in Bon Secours Health System’s Advanced Medical Home program, and Nurse Case Managers at the heart of CDPHP’s Enhanced Primary Care effort.