When your brain becomes stimulated by the phone, you will end up staying awake for longer. It no longer has the opportunity to shut down itself. When you use the phone in bed, you are keeping your brain psychologically active. You might not think about this very often, but your brain needs a break from time to time. If you are the type of person that has trouble shutting down their phone for the night, you are probably going to be kept awake as a result. The difference is that you can literally take care of those tasks anywhere that are. The phones of today allow you to do just about anything that you could do on a personal computer. Beyond that, it is much more than just a tool to talk to your friends and family. Now, your phone seems to always be with you. Employers who take the time to ensure a healthy care management process will benefit from positive health and financial outcomes as their employees reach their optimum level of wellness, self-care management, and functional capability.Gone are the days when you had to run to the kitchen just to answer the one telephone in the house. Under an employer-sponsored, self-insured health plan, the employer ultimately pays for any inefficiencies associated with the delivery of care management services. Little or no integration with other clinical programs such as EAP’s, employee clinics, and wellness programs.Delays in concurrent reviews and discharge planning.Inconsistent application of clinical criteria.Poorly executed policies and procedures.Ineffective/ inadequate nursing interventions.Lack of timely identification of candidates.The findings can also help to identify opportunities and inconsistencies that can create financial risk and reduced value unless corrected. Program improvementsĪ care management audit is an ideal way to evaluate the care management program’s operational strengths and weaknesses and ability to impact health and financial outcomes. For employers who have additional care management programs such as disease management and wellness, it’s also important to ensure that coordination within and between programs is working well. The goal is to assure program integration, promote early identification of problem areas, evaluate the appropriateness of interventions, and help ensure the program is providing an efficient, well-coordinated, and valuable experience for the member. Care management program auditĪn audit should include a review of processes designed to assess not only the program structure, but also program execution and the audit’s subsequent impact on health and financial outcomes. To ensure these patients receive the best possible quality and most cost-effective care, it’s important to conduct regular care management coordination and oversight audits. While claims, eligibility, and pharmacy audits are common, many employers do not evaluate the delivery of care management programs, their impact on member health, and financial outcomes. Make sure your care management program delivers resultsĬare management programs are typically delivered by your organization’s self-funded health plan, TPA or third-party vendor, and include a number of offerings that assist members along the health care continuum. Unfortunately, many care management programs fall short of these goals. It has been widely observed that a good case management process can reduce the length of stays in hospital, diminish prescription errors, reduce duplicate testing, and lower readmission rates. They also help patients to access the most appropriate level of care, coordinate services, support patients and families, and reduce unnecessary complications and costs. Focusing care management services on your sickest plan members can not only improve the patient experience, but it may also reduce duplicate services and minimize low-value or inappropriate services.Įffective care management programs are designed to ensure that medical interventions meet accepted clinical criteria for coverage under the plan. The goal of care management is to ensure members receive quality health care services in a cost-effective manner. So, a well-run care management program should always be part of your organization’s cost containment strategy. Nearly half the medical and pharmacy expenditures for a self-funded plan stem from claims for medical care for high-to-catastrophic illnesses.
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