Disease Management VS. Case Management VS. Utilization Management

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Disease Management VS. Case Management VS. Utilization Management.
Utilization Management involves a nurse from the insurance carrier approving 'bed days' for a hospitalized plan member.
Case Management involves a nurse from the insurance carrier trying to reduce or stop readmission of plan members that have been discharged from the hospital to 1) Acute Rehab, 2) a Skilled Nursing Facility or 3) a Long-Term Acute Care Facility.
Disease Management involves a nurse from the insurance carrier or disease management vendor working with the patient and his or her doctors and other providers to manage a chronic disease such as 1) Diabetes, 2) COPD, 3) Congestive Heart Failure or 4) Chronic Kidney Disease.
The way VALUE should be measured for Utilization Management vs. Case Management vs. Disease Management is very different and is discussed in detail in the video with examples.
Sources:
www.ajmc.com/v...
cmsa.org/
diseasemanagem...
www.urac.org/a....
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Пікірлер: 27

@jefffrater-lifewithasmirk Жыл бұрын

Dr. Bricker: I’ve seen a number of your videos and appreciate you, your service and knowledge. This is the first time I found a number of items to disagree about, either through omission or nuanced difference. But your description of case management sounded very off from what I see first hand and the commonly accepted definition by both the Case Management Society of America and the Commission for Case Management certification: “Case Management is a dynamic process that assesses, plans, implements, coordinates, monitors, and evaluates to improve outcomes, experiences, and value.” I’ll email my other thoughts which you may choose to highlight in the future.

@ahealthcarez Жыл бұрын

Thank you for sharing your point of view.

@nalaamour 8 ай бұрын

Case managers in the hospital settings do interact with patients and families. They go into the rooms and speak with patients to help coordinate their care.

@ahealthcarez 8 ай бұрын

Thank you for watching and for your comment.

@ericklou2013 Жыл бұрын

Thank you for taking the time to explain this Healthcare concepts. I've worked in Healthcare for quite some time and there is no training or education on explaining these.

@ahealthcarez Жыл бұрын

Thank you for watching and for your feedback.

@15ranvijay 5 ай бұрын

Beautifully explained but I hope you can include more detailed benefits as an outcome of clinical programs. As measured in terms of the readmission ratio, PMPM savings, member risk improvement, etc. You could involve a Risk stratification strategy to cater to the patient population and link to clinical programs to address the gaps in care and involve clinicians in the right care at the right time and the right treatment.

@ahealthcarez 5 ай бұрын

Thank you for sharing your thoughts.