9. HOW WE DO IT… Phoenix Medical Management, I:nc. Solutions for Hospital Case Management BREAKTHROUGH TRANSFORMATION™ HCM v1.0 CLINICAL NURSE PRACTICE MODELS HCM v2.0 FUNCTIONAL MODELS HCM v2.1 FUNCTION MODELS/CONSOLIDATED ROLES HCM v2.2 FUNCTIONAL MODELS/INTEGRATED ROLES HCM v3.0 OUTCOME MODELS An outcome model of hospital case management is a collaborative process between the case manager and the physician, the patient, and the clinical team to proactively advocate and support the patient’s progression-of-care through the hospitalization and into the community.
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Editor's Notes
With the Balanced Budget Act of 1997, reimbursement will continue to change over the next 1-5 years affecting all facets of care delivery. The new reimbursement models provide for reduced reimbursement in the home health, long term care and ambulatory settings. It forces health care delivery systems to approach care delivery with a more integrated and “systems” approach. The focus needs to be on processes that streamline care delivery and integrate delivery processes Population management by the primary providers More emphasis on wellness and prevention to reduce the provider’s risk, particularly those associated with chronic illnesses Change in focus from episodic care to disease management, but understanding that there are limited, if any, outcomes of disease management due to the high enrollee turnover rate (25-30% VHA, Delliotte & Tuse), and enrolles are in a plan for about 2yrs. This makes it extremely difficult to measure outcomes. This requires integration of delivery models, involvement and participation of all stakeholders, cost control, and opportunities to identify new markets.