Case Management

Medicare Advantage and Case Management

Posted on by Dominick Flarey

Medicare Advantage plans are increasingly popular among America’s seniors, offering a coordinated and benefit-rich alternative to traditional Medicare. These plans, provided by private insurance companies and paid for on a capitated basis by the Centers for Medicare and Medicaid Services (CMS), have become a significant part of the healthcare landscape. With comprehensive coverage options, financial implications, and accessibility considerations, Medicare Advantage is reshaping the way beneficiaries receive and manage their healthcare needs. This article explores the benefits of Medicare Advantage healthcare plans across various dimensions.

Case Managers have an expert knowledge of medicare. Please also review AIHCP’s Case Management Certification

Healthcare and Case Managers can play a key role in guiding patients in understanding Medicare Advantage, as well as understanding its implication with patient payments.  Please also review AIHCP’s Case Management Certification Program and see if it meets your academic and professional goals.

Key Takeaways

  • Medicare Advantage plans offer supplemental benefits such as dental and vision coverage, which are particularly attractive to underserved populations.
  • The capitated payment model of Medicare Advantage promotes efficient use of resources, ensuring plans can meet patient needs while maintaining fiscal responsibility.
  • Enrollment in Medicare Advantage plans is growing, with accurate payments playing a pivotal role in the sustainability of Medicare spending.
  • Quality of care in Medicare Advantage plans is comparable to traditional Medicare, with some variations in care delays due to prior authorization requirements.
  • Medicare Advantage is facing policy debates and legal challenges, yet continues to innovate in plan offerings and member experience, signaling a dynamic future.

Comprehensive Coverage Options in Medicare Advantage Plans

Incorporation of Supplemental Benefits

Medicare Advantage (MA) plans distinguish themselves from Traditional Medicare by offering a range of supplemental benefits, addressing a variety of healthcare needs beyond the standard coverage. The inclusion of these benefits is a significant factor in the decision-making process for beneficiaries, particularly among underserved populations.

  • Over-the-counter medication allowances
  • Dental benefits
  • Vision benefits

These supplemental offerings not only enhance the attractiveness of MA plans but also contribute to their comprehensive nature. Seven out of ten MA enrollees have utilized at least one supplemental benefit in the past year, with over-the-counter medications being the most popular.

The strategic incorporation of supplemental benefits into MA plans is pivotal in providing a holistic approach to healthcare, ensuring that beneficiaries have access to a broader spectrum of services.

The table below illustrates the prevalence of supplemental benefit usage among MA enrollees:

Benefit Type Percentage of Enrollees Using Benefit
Over-the-counter medications 70%
Dental benefits Not specified
Vision benefits Not specified

It is evident that these additional benefits are not merely ancillary but are integral to the value proposition of Medicare Advantage plans. They serve to fill gaps in coverage that are not addressed by Traditional Medicare, thereby offering a more tailored and potentially more satisfying healthcare experience.

Variability of Dental and Vision Coverage

The landscape of dental and vision coverage within Medicare Advantage plans is marked by significant variability, influenced by factors such as demographic differences and plan selection. A notable portion of Medicare Advantage beneficiaries, nearly one-third, lacked dental coverage in 2019. However, coverage was more prevalent among historically underserved populations, suggesting targeted efforts to bridge gaps in care.

Medicare Advantage plans often tout extensive provider networks for vision care, with benefits that may include routine eye exams and allowances for contacts or frames. Yet, the actual availability of these benefits can differ greatly by local market and plan specifics. For example, a plan may cover standard lenses fully on an annual or biennial basis, but the retail network and the extent of coverage for designer frames can vary.

The choice of plan can have significant financial implications for beneficiaries, especially when considering out-of-network services. Plans may offer out-of-network dental coverage, but beneficiaries could face higher costs, even for services listed as $0 copay.

Ultimately, the value of coverage is contingent upon the specific benefits offered and the service area. Medicare Advantage’s largest national dental network provides access to a wide range of services, from preventive care to more complex procedures like root canals and dentures. However, beneficiaries must navigate the intricacies of their plan’s features, limitations, and exclusions to fully understand the coverage they are entitled to.

Impact of Star Ratings on Plan Quality

The Centers for Medicare & Medicaid Services (CMS) star ratings are a critical factor in assessing the quality of Medicare Advantage (MA) plans. These ratings, which range from 1 to 5 stars, with 5 being the highest, serve as a guide for consumers in choosing a plan and have direct financial implications for the insurers. Plans achieving four or more stars are rewarded with monetary bonuses, which are mandated to be reinvested into improving plan benefits.

The quality of Medicare to provide what it promises is essential.  Please also review AIHCP’s Case Management Program

For 2024, the average star rating across all MA plans has seen a slight decrease to 4.04 from the previous year’s 4.15. This decline may appear marginal, but it carries significant weight in the competitive landscape of MA plans. Insurers are keenly aware of the impact these ratings have on consumer perception and their bottom line, prompting a strategic focus on enhancing quality measures to boost ratings.

The star rating results may sound marginal, but they have huge financial impact.

The table below illustrates the top reasons enrollees chose MA plans over traditional Medicare in 2022, highlighting the importance of additional benefits which are often enhanced by the use of star rating bonuses:

Reason for Choosing MA Plan Percentage of Enrollees
More benefits 24%
Out-of-pocket limit 20%
Recommended by trusted people 15%
Offered by former employer 11%
Maintain same insurer 9%

As the landscape of Medicare Advantage evolves, the role of star ratings in shaping plan quality remains a pivotal aspect of the industry, influencing both consumer choices and the strategic direction of payers.

The Financial Implications of Medicare Advantage Enrollment

Capitated Payment Model and Its Efficiency

The capitated payment model under Medicare Advantage represents a fundamental shift from the traditional fee-for-service (FFS) approach. Plans receive a set amount per enrollee, which incentivizes the efficient management of care. This model encourages providers to focus on preventative measures and coordinated care, potentially leading to cost savings and improved patient outcomes.

  • The capitated model aligns payment with patient health needs rather than the volume of services provided.
  • It simplifies the billing process for providers, reducing administrative overhead.
  • By receiving a fixed payment, plans are motivated to manage resources effectively to cover all necessary services.

The efficiency of the capitated payment model is evident in its ability to streamline care delivery and align financial incentives with patient health. However, it also introduces the need for careful oversight to ensure that care quality is not compromised in the pursuit of cost savings.

While the capitated model has its advocates, it is not without controversy. Methodological changes in payment calculations can significantly impact plan revenue and stability. Plans and providers have expressed concerns that such changes could jeopardize their ability to deliver consistent, affordable benefits.

The Role of Accurate Payments in Sustaining Plan Viability

The sustainability of Medicare Advantage plans is heavily reliant on the precision of payments made to these plans. Accurate payments are crucial for ensuring that plans can provide necessary healthcare services to beneficiaries while maintaining fiscal responsibility with taxpayer funds. The Centers for Medicare & Medicaid Services (CMS) has recognized this balance and proposed a 3.7% increase in payments for 2025, which translates to an additional $16 billion for Medicare Advantage plans.

The debate over Medicare spending efficiency is intensifying as Medicare Advantage enrollment grows. The payment structure to these plans is a pivotal factor in this discussion, with the goal of meeting patient needs without compromising the program’s long-term viability.

The payment update process is not without controversy. Methodological changes by CMS can significantly impact plan revenue, leading to disputes over the potential effects on the stability and affordability of benefits. For instance, recent objections from insurers and providers have resulted in a phased implementation of revisions to the risk adjustment model over three years.

  • Key Points:
    • Accurate payments support plan viability and patient care.
    • CMS’s proposed payment increase reflects the growing importance of Medicare Advantage.
    • Payment methodology changes can provoke industry pushback.
    • Ongoing debates focus on the balance between patient needs and Medicare spending sustainability.

Cost Comparisons with Traditional Medicare

When evaluating the cost-effectiveness of Medicare Advantage plans compared to Traditional Medicare, beneficiaries often consider the monthly base costs and additional expenses. Medicare Advantage plans may offer a $0 premium option, which can be particularly attractive, but it’s essential to factor in the costs of Part B and any additional benefits.

Medicare Type Part A Premium Part B Premium Part D Premium
Traditional Medicare Typically $0 Starts at $174.70 Varies
Medicare Advantage $0 option available Included in plan Often included

While Medicare Advantage plans can provide cost savings, especially with bundled services, the out-of-pocket expenses can differ significantly. Beneficiaries must weigh the trade-offs between lower premiums and potential copayments or coinsurance costs for services covered.

It is crucial for individuals to thoroughly analyze their healthcare needs and financial situation before deciding on a plan. The choice between Medicare Advantage and Traditional Medicare hinges on a balance of cost, coverage, and flexibility.

Medicare Advantage’s Role in Addressing Healthcare Accessibility

Meeting the needs of all populations.

Recent data indicates a significant shift in Medicare Advantage (MA) enrollment patterns, particularly among underserved populations. UnitedHealth Group reported a substantial increase in enrollment, with 1.7 million new consumers in 2023, suggesting a growing reliance on MA plans. This trend is echoed in the choices of beneficiaries with lower income or educational attainment, who are increasingly opting for plans that offer supplemental benefits, such as dental and vision coverage.

The distribution of MA plan offerings has seen notable regional variations. For instance, Alabama experienced a notable reduction in MA offerings, with 20 fewer plans available from 2023 to 2024. This contrasts with the overall growth in MA enrollment, highlighting the disparities in plan availability across different areas.

The concentration of MA markets remains high in metropolitan areas, with a single payer often dominating the market share. This could have implications for competition and choice for beneficiaries.

Furthermore, the demographic breakdown of MA plan coverage reveals that almost a third of beneficiaries lacked dental coverage in 2019. However, underserved populations were more likely to be enrolled in plans that included such coverage, indicating a targeted approach to addressing the needs of these groups.

Supplemental Benefits and Their Impact on Care Access

Medicare Advantage (MA) plans have increasingly incorporated supplemental benefits, addressing a range of nonmedical needs that significantly influence care access. These benefits, which often include dental, vision, and over-the-counter medication allowances, are particularly attractive to underserved populations.

The inclusion of supplemental benefits in MA plans has been a decisive factor for many beneficiaries, especially those from lower-income or educationally disadvantaged backgrounds.

Recent data indicates a strong preference among Black Medicare Advantage beneficiaries and those with lower socioeconomic status for plans offering these additional services. The Commonwealth Fund reports that a substantial majority of MA enrollees utilized at least one supplemental benefit in the past year, highlighting the importance of these benefits in their healthcare decisions.

The table below summarizes the utilization of supplemental benefits among MA enrollees:

Benefit Type Percentage of Enrollees Using Benefit
Over-the-counter medications 70%
Dental benefits Included in the 70%
Vision benefits Included in the 70%

While supplemental benefits are a significant draw, it’s important to note that Medicare Advantage enrollees are more likely to report care delays due to prior authorization requirements compared to those in traditional Medicare. This suggests that while access to additional services is enhanced, there may be barriers within the MA system that need addressing to ensure timely care.

Survey Insights on Care Delays and Prior Authorization

Recent surveys have highlighted a significant disparity in care delays between Medicare Advantage (MA) enrollees and those in traditional Medicare. A 2024 survey from the Commonwealth Fund revealed that 22% of MA enrollees experienced delays in receiving care due to the need for prior authorization, in contrast to just 13% of traditional Medicare beneficiaries.

The implementation of new CMS rules aimed at streamlining the prior authorization process is anticipated to mitigate these delays and enhance the efficiency of health information exchange.

The finalized CMS rule mandates that MA carriers provide specific reasons for denying requests and report prior authorization metrics. Decisions on urgent requests must be communicated within 72 hours, and within seven days for standard requests. This regulatory change is expected to save an estimated $15 billion over the next decade.

Evaluating the Quality of Care in Medicare Advantage

Quality of care is a key concern. Please also review AIHCP’s Case Management Program

Comparative Analysis of Medicare Advantage and Traditional Medicare

The landscape of Medicare is evolving, with a significant shift towards Medicare Advantage (MA) plans. These plans are increasingly favored for their comprehensive benefits and managed care approach. Medicare Advantage patients were more likely to be discharged to the community compared with those in Traditional Medicare, indicating a difference in care coordination and post-acute care strategies.

However, the quality of care and patient outcomes remain central to the debate. While some studies suggest that MA can lead to better health outcomes, others highlight potential care delays. For instance, enrollees in MA are more likely to experience delays due to prior authorization requirements. This underscores the need for a nuanced understanding of how these two Medicare models impact patient care.

The comparison between Medicare Advantage and Traditional Medicare is not just about coverage, but also about the efficiency and outcomes of the care provided.

The following table summarizes key differences in outcomes and services between Medicare Advantage and Traditional Medicare:

Outcome/Service Medicare Advantage Traditional Medicare
Hospital Readmission Rates 70% lower Higher
Reported Care Delays 22% 13%
Use of Supplemental Benefits 70% of enrollees Not applicable

These differences highlight the importance of individual needs and preferences when choosing between Medicare Advantage and Traditional Medicare.  It is important for case managers to have a full understanding of the two systems and the benefits and disadvantages of both. Case Managers play key roles in the healthcare process in helping patients find better outcomes but also working within the health insurance and medicare fields.

Influence of Medicare Advantage on Health Outcomes

The impact of Medicare Advantage (MA) on health outcomes has been a focal point of research and policy discussions. Studies indicate that MA enrollees may experience different health outcomes compared to those in traditional Medicare. For instance, a 2023 white paper highlighted a significant difference in hospital readmission rates, with MA enrollees having 70% lower rates than their counterparts in fee-for-service Medicare.

However, the picture is not uniformly positive. Reports suggest that MA enrollees are more likely to experience delays in care, often due to the need for prior authorization. A 2024 survey from the Commonwealth Fund found that 22% of MA enrollees reported such delays, in contrast to 13% with traditional Medicare.

The utilization of supplemental benefits within MA plans is noteworthy, with seven out of ten enrollees reporting the use of at least one supplemental benefit in the past year. This suggests a correlation between the availability of supplemental benefits and patient engagement in managing their health.

The ongoing debate about the efficiency and sustainability of Medicare spending is closely tied to the performance of MA plans. Accurate payments to these plans are crucial for ensuring that they can efficiently meet the health needs of enrollees while also being mindful of taxpayer dollars.

The Medicare Advantage (MA) Star Ratings system, designed to measure the quality of health plans, has recently come under legal scrutiny. Elevance Health has initiated a lawsuit against the Department of Health and Human Services, challenging the methodology used to calculate these ratings. The suit claims that the changes to the star ratings are not only unlawful but also detrimental to the plans’ ability to showcase their quality.

The star ratings are critical as they influence consumer choice and determine the bonus payments to insurers. A decline in the number of plans achieving 5-star ratings has been observed, which could have significant financial implications for the plans and their members. This legal challenge underscores the tension between regulatory oversight and the insurance industry’s operational autonomy.

The legal dispute over the MA star ratings system highlights the complexity of balancing regulatory intent with the practicalities of plan management and market competition.

The outcome of this lawsuit could set a precedent for how quality metrics are developed and enforced, potentially impacting the future landscape of Medicare Advantage plans.

Projected Growth and Its Implications for Medicare Spending

The trajectory of Medicare Advantage (MA) enrollment is a critical factor in forecasting future Medicare expenditures. With MA constituting over half of all Medicare enrollment in 2024 and an anticipated 60% by 2030, the financial implications for Medicare spending are substantial. The increase in MA plan payments by 3.7 percent, or $16 billion in 2025, underscores the growing fiscal impact of this program.

The projected growth of Medicare Advantage is set against a backdrop of rising healthcare costs, with federal actuaries predicting total healthcare expenditures to reach $7.2 trillion by 2031.

The availability of MA plans has seen a slight decrease, with 3,959 plans offered nationwide in 2024, representing a 1% drop from the previous year. Despite this, the average beneficiary still has a choice of 43 MA plans. The implications of these trends on Medicare’s budget are a matter of ongoing policy debate, focusing on the balance between cost, access, and quality of care.

Year MA Enrollment Percentage Number of MA Plans Average Plans per Beneficiary
2024 50%+ 3,959 43
2030 Projected 60% N/A N/A

Policy Debates Surrounding Payment Structures

The payment structures of Medicare Advantage (MA) plans are at the heart of ongoing policy debates. As MA enrollment swells, the mechanisms and magnitude of payments to these plans are scrutinized for their impact on both patient care and taxpayer dollars. The Centers for Medicare & Medicaid Services (CMS) periodically updates payment methodologies, which can lead to contentious discussions among stakeholders. For instance, recent methodological changes proposed by CMS have sparked significant debate, with some plans arguing that these changes could compromise their ability to provide stable and affordable benefits.

The flexibility of interpretation around current MA risk adjustment coding guidelines has been identified as a core issue by some experts. This flexibility can lead to variability in how plans are compensated, potentially affecting the quality and cost of care provided to beneficiaries.

Efficient payment models are crucial for the sustainability of MA plans. They must balance the need to adequately fund health services with the responsibility of prudent fiscal management. The debate continues as policymakers, insurers, and providers seek common ground to ensure that MA plans can continue to deliver value to their members.

Innovations in Plan Offerings and Member Experience

The landscape of Medicare Advantage plans becomes a canvas on which insurers craft innovative designs tailored to meet the diverse needs of beneficiaries. These innovations are not just limited to the types of coverage offered, but also extend to enhancing the overall member experience. Insurers are increasingly leveraging technology to streamline processes and provide more personalized care.

  • Securing top Star Ratings has become a priority, driving plans to innovate in quality and outcomes.
  • Generative AI is transforming payer productivity and member support, indicating a shift towards more tech-driven solutions.
  • Regional plans are finding success by outsmarting larger competitors with unexpected and agile innovations.

The focus on member experience is evident in the efforts to overcome care management barriers and the emphasis on securing high Star Ratings.

The innovations in Medicare Advantage plans are not only shaping the current healthcare landscape but are also setting the stage for future developments. As these plans evolve, they continue to influence Medicare spending and policy debates, underscoring the importance of continuous improvement and adaptation in the face of changing healthcare needs.

Conclusion

Case Management is essential to any programs efficiency. Please also review AIHCP’s Case Management Certification

In summary, Medicare Advantage plans represent a significant evolution in the provision of healthcare services to America’s seniors. By offering Medicare benefits through private insurance plans, these alternatives to traditional Medicare have become the preferred choice for a growing number of beneficiaries, now accounting for about half of all enrollees. The capitated payment system to Medicare Advantage plans by CMS ensures that patient health needs are met while maintaining efficient use of taxpayer dollars. As the debate over Medicare spending continues, the focus on the payment and sustainability of these plans will remain central. Moreover, the additional benefits provided by Medicare Advantage, such as dental and vision coverage, cater to the diverse needs of beneficiaries, particularly those underserved. However, challenges such as care delays due to prior authorization requirements highlight areas for improvement. Ultimately, the value of Medicare Advantage lies in its ability to deliver high-quality coverage and care, balancing the needs of seniors with fiscal responsibility.

Please also review AIHCP’s Case Management Certification Program.  The program is designed for nurses and health care professionals looking to help patients manage their health and health care policies.  The program is online and independent study and open to qualified professionals seeking a four year certification in Case Management.

Frequently Asked Questions

What is Medicare Advantage and how does it differ from traditional Medicare?

Medicare Advantage, also known as Medicare Part C, offers Medicare benefits through private insurance plans as an alternative to traditional Medicare. Unlike traditional Medicare, which is directly administered by the federal government, Medicare Advantage plans are offered by private insurers and are paid on a capitated basis by the Centers for Medicare and Medicaid Services (CMS) to cover healthcare services for enrollees.

How do accurate payments affect Medicare Advantage plans?

Accurate payments to Medicare Advantage plans are crucial for ensuring that these plans can meet patients’ health needs while making efficient use of taxpayer dollars. They are central to the sustainability of Medicare spending as they help maintain the financial viability of the plans.

What supplemental benefits are available with Medicare Advantage plans?

Medicare Advantage plans may include supplemental benefits such as dental and vision coverage, which are not typically covered under traditional Medicare. These benefits can vary by plan and demographics, and they are designed to provide additional healthcare resources to enrollees.

Underserved populations, including Black beneficiaries and those with lower income or educational attainment, are more likely to choose Medicare Advantage plans that include supplemental benefits. These trends indicate that Medicare Advantage is addressing the needs of diverse populations by offering plans with additional coverage options.

How does the quality of care in Medicare Advantage compare to traditional Medicare?

The quality of care in Medicare Advantage plans is generally similar to that in traditional Medicare, with some differences in care delays and health assessments. Medicare Advantage enrollees are more likely to report delays in care due to prior authorization requirements compared to those in traditional Medicare.

What is the future outlook for Medicare Advantage plans?

Medicare Advantage plans are expected to continue growing in popularity, which has implications for Medicare spending. Policy debates are ongoing regarding the payment structures for these plans, and there is a focus on innovations in plan offerings and member experiences to enhance value and quality of care.

Additional Resources

Lankford, K. (2022). “What is Medicare Advantage?”. AARP.  Access here

Harris. T. (2024). “Best Medicare Advantage Plans For 2024”. Forbes.  Access here

“What’s a Medicare Advantage Plan?” (2015).  Access here

“Understanding Medicare Advantage Plans”. Access here

Ashford, K. (2022). “Medicare vs. Medicare Advantage: Which Should I Choose?”. Nerd Wallet.  Access here 

 

The Growing Role of AI In Healthcare Management Systems

Posted on by Joseph Gerard

View of Doctor holding Artificial intelligence icon with half brain and half circuit 3d rendering

Written by Claire Ward

The recent advances in generative AI is no secret, and their impact on various businesses and industries is undeniable. Yet, one area that remains relatively under-the-radar in this regard is healthcare management, where legacy systems, processes, and technologies continue to dominate.

Healthcare management is often riddled with inefficiencies, ranging from excessive paperwork, to redundant systems and processes. These inefficiencies eventually end up getting passed onto consumers, either in the form of increased wait-times for crucial procedures, or unaffordably high prices.

Fortunately, the rising tide of AI has left no-stone-unturned, and is headed for the stubborn walls of global healthcare in all its fury. In this article, we take a deep dive into the exciting changes taking place within this industry, and its implications for patients, practitioners and other stakeholders.

Enhancing Efficiencies With Streamlined Operations

Over the normal course of operations, a significant portion of time and resources in a medical practice gets lost in largely unproductive activities. This includes billing, filing insurance claims, managing medical records, and a lot more.

As a result, the bureaucratic bloat in the industry has grown to unfathomable levels today, outnumbering physicians and nurses 10 to 1. This is clearly unsustainable, and leaves plenty of room for AI-enabled tools to work their magic and unlock substantial value in the days ahead.

AI, when applied to existing EHR and healthcare management systems can help automate numerous routine administrative processes, in addition to scheduling appointments, optimizing resource allocations, and reducing paperwork substantially.

The last decade saw a steady rise in the use of a management system for health homes, unlocking massive efficiency gains in the process. The 2020s will take this further by pairing the same tools and systems with AI, with limitless possibilities and potential for disruption.

Improving Diagnostics

Most errors and instances of malpractice in healthcare take place in the diagnostics stage, and as a result, the use of AI-enabled tools can help unlock substantial value for patients, practitioners and the broader industry alike.

No matter how experienced and skilled physicians get, they can never match machine learning algorithms when it comes to analyzing vast amounts of patient data and coming up with insights based on the same, often at a small fraction of the time and effort.

In recent years, plenty of AI-enabled tools have entered the fray, offering enhanced capabilities for radiologists when it comes to detecting anomalies that can be missed by clinicians. The capabilities of these tools still remain at nascent stages, but are growing exponentially each passing year.

Clinicians, however, need not worry about being replaced by AI, after all, patients place their trust on other human beings, never bots or programs. Radiologists have feared technology replacing them for over two decades, but despite the monumental advances, disruptive tech has only served to augment their capabilities and expand their reach.

Enhancing Patient Engagement

Technologies such as wearable devices, smartphones, and personalized health information have already done wonders in enhancing patient engagement, but add AI to the mix, and the result is absolutely phenomenal.

There are endless possibilities when legacy technologies are matched with advanced generative AI, particularly when it comes to healthcare. Right off the top, we imagine use cases such as chatbots, which can answer questions for patients, clarify doubts regarding their records, appointments, treatments, and more, without having to disturb a doctor or nurse in the process.

In addition to this, doctors have an option to remotely monitor their patients, get alerted about abnormalities right away, before they turn into life threatening emergencies.

Doctor And Robot Shaking Hands

Facilitating Data-Driven Decision Making

Data is at the core of healthcare management systems, and the volume of healthcare data is growing exponentially. AI algorithms have the ability to process and analyze large datasets, uncovering meaningful insights that can inform decision making.

For instance, AI can identify population health trends, predict disease outbreaks, and optimize resource allocation based on real-time data. By leveraging AI’s capabilities, healthcare organizations can make data-driven decisions that have the potential to improve patient outcomes, reduce costs, and enhance overall healthcare quality.

Hospitals, nursing homes and clinics have long generated copious amounts of data, which have largely gone unused for the most part. With AI and advanced analytics, this data can finally be put to use, helping practitioners add plenty of value to patients in the long-run.

Addressing Ethical & Privacy Concerns

While the potential benefits of AI in healthcare management systems are immense, it is important to address the ethical, privacy, and security concerns associated with its use. As AI algorithms rely heavily on data, it is crucial to ensure patient data privacy and security.

Striking the right balance between data access for AI systems and protecting patient confidentiality is a complex challenge that requires robust data governance frameworks and regulatory oversight.

Additionally, ethical considerations such as transparency, accountability, and fairness in algorithmic decision-making processes must be carefully addressed to maintain trust in AI-powered healthcare systems.

Many of the ethical and privacy concerns pertaining to the use of AI for healthcare are yet to even be fully understood.

The issues will only come to light when there have already been instances of abuse, and this makes it pertinent to have ethical frameworks in-place, in addition to laws and regulatory frameworks, which often tend to be outdated fairly quickly, as more and more disruptive technologies come to fore.

The Road Ahead: Collaboration & Human-AI Partnership

As we embrace the growing role of AI in healthcare management systems, it is essential to recognize that AI is not a replacement for human healthcare professionals but a tool to augment their capabilities.

Collaboration between humans and AI is key to harnessing the full potential of this technology, and as such, any resistance to the adoption of such technologies must be dealt with using extensive training and awareness programs for all stakeholders involved.

Healthcare organizations should invest in training their workforce to understand and effectively utilize AI-powered systems, fostering a culture of continuous learning and adaptation. By embracing a human-AI partnership approach, we can ensure that AI serves as a valuable ally in delivering high-quality, patient-centered care.

 

 

Please also review AIHCP’s Health Care Certificate Programs and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification.

Unequal Access and Disparity in Healthcare

Posted on by Dominick Flarey

The goal of the healthcare system is to grant equal access to the finest care for anyone but this is not the case and is a goal that has not been achieved.  Poorer demographic areas, minorities, and more rural areas all face less and equal access as richer and more urban areas.  Those with a bigger wallet or who live in a more wealthy and urban area have an incredible advantage over others.  This calls for a large call for sweeping reforms in healthcare and its delivery to the nation’s more vulnerable.  It calls for better laws, better healthcare programs and more healthcare facilities to meet the growing needs of the population.  These are many issues that Case Managers have to face with patients.

Not everyone has the same access to good healthcare. Please also review AIHCP’s Healthcare Case Management Program

 

The article, “What is health inequity?” by Jayne Leonard looks at the nature of health inequity and how it differs from the term healthcare inequality.  The article gives various examples of how these terms relate to the real world and what groups and areas face more challenges.  Leonard states,

“Health inequity refers to avoidable differences in health between different groups of people. These widespread differences are the result of unfair systems that negatively affect people’s living conditions, access to healthcare, and overall health status. Health inequity affects people from disadvantaged or historically oppressed groups most severely. However, it has a negative impact on everyone. This article will look at health inequity in more detail, explaining how it differs from health inequality and its impact.”

What is health inequity?. Jayne Leonard. May 16th, 2021. MedicalNewsToday.

To read the entire article, please click here

Commentary

Health disparities are a complex issue that has been a long-standing problem in healthcare. They arise from various social, economic, and environmental factors such as poverty, education, race, ethnicity, and geography. These disparities cause differences in access to healthcare, quality of care, and health outcomes. Health disparities have a significant impact on individuals and communities, leading to increased morbidity and mortality rates, reduced quality of life, and increased healthcare costs.  This type of unequal access is an issue for healthcare providers and case managers attempting to ensure their patients receive the best care.

Understanding the Causes of Health Disparities

As in most cases, poverty and poverty stricken areas play the largest role in healthcare inequity and disparity. Please also review AIHCP’s Case Management Program

 

Health disparities are caused by a combination of factors, including social determinants of health, access to healthcare, and individual behavior. Social determinants of health are the conditions in which people are born, grow, live, work, and age. These determinants include factors such as poverty, lack of education, poor housing conditions, and lack of access to healthy food options. Access to healthcare is another critical factor in health disparities. People who live in low-income areas or rural areas often lack access to quality healthcare services, resulting in poor health outcomes. Lastly, individual behavior such as smoking, alcohol consumption, and lack of physical activity can also contribute to health disparities.

The Impact of Health Disparities on Individuals and Society

The impact of health disparities is far-reaching and affects individuals and society as a whole. Individuals who experience health disparities are more likely to suffer from chronic diseases such as diabetes, heart disease, and cancer. They are also more likely to have shorter lifespans and experience higher mortality rates. Health disparities also have a significant economic impact on society. The cost of treating preventable diseases that arise from health disparities is estimated to be around $93 billion per year in the United States alone.

Examples of Health Disparities

Poverty and race play key roles in healthcare disparity

 

Health disparities exist across a range of health outcomes, including infant mortality rates, life expectancy, and chronic disease prevalence. For example, African American infants are twice as likely to die before their first birthday compared to white infants. Women of color are more likely to be diagnosed with advanced stages of breast cancer and are more likely to die from the disease than white women. Native Americans have a higher prevalence of diabetes and are more likely to die from the disease than any other racial or ethnic group.

The Cost of Health Disparities

Health disparities not only have a significant impact on individuals and society but also come at a high cost. The cost of treating preventable diseases that arise from health disparities is estimated to be around $93 billion per year in the United States alone. This cost includes direct medical costs, such as hospitalization and medication, as well as indirect costs, such as lost productivity and reduced quality of life.

Addressing Health Disparities through Policy and Advocacy

Addressing health disparities requires a multi-faceted approach that involves policy and advocacy. Policy solutions such as expanding access to healthcare, increasing funding for health education programs, and improving economic and social conditions can help reduce health disparities. Advocacy efforts can also play a critical role in addressing health disparities. Community-based organizations can advocate for policies that address the root causes of health disparities and work to educate the public about the importance of health equity.

The Role of Healthcare Providers in Reducing Health Disparities

Healthcare providers and case managers can play key roles in helping patients and people find equal access to care

 

Healthcare providers have a crucial role to play in reducing health disparities. Providers can work to ensure that all patients have access to quality healthcare services regardless of their race, ethnicity, or socioeconomic status. Providers can also work to address cultural and linguistic barriers that may prevent patients from accessing care. Additionally, providers can work to improve health literacy by providing patient education and resources that help patients better understand their health conditions.  Case Managers can also play a role within their healthcare facility in attempting to help individuals receive the care they need.

Community-Based Solutions for Reducing Health Disparities

Community-based solutions are another critical component of addressing health disparities. Community organizations can work to address the root causes of health disparities by providing education, resources, and support to individuals and families. These organizations can also work to improve access to healthcare services by providing transportation, language services, and other resources that help remove barriers to care. Community-based solutions are particularly effective in addressing health disparities in marginalized communities.

The Importance of Addressing Social Determinants of Health

Addressing social determinants of health is critical to reducing health disparities. Social determinants such as poverty, lack of education, and poor housing conditions have a significant impact on health outcomes. By addressing these determinants, we can help reduce health disparities and improve health outcomes. Strategies for addressing social determinants of health include increasing access to affordable housing, improving educational opportunities, and increasing economic opportunities.

Conclusion – Moving towards Health Equity

Health disparities are a complex issue that requires a multi-faceted approach to address. By understanding the causes and impact of health disparities, we can work to develop policies and programs that help reduce these disparities. Healthcare providers, community organizations, and policymakers all have a critical role to play in addressing health disparities. By working together, we can move towards health equity and ensure that all individuals have access to quality healthcare services and the opportunity to live healthy, fulfilling lives.

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals

 

As healthcare professionals, we have a responsibility to advocate for health equity and work towards reducing health disparities.  Healthcare professionals and healthcare case managers can work with providers and other aspects to help ensure everyone receives the healthcare and treatment they need.

Please also review AIHCP’s Healthcare Case Management Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified healthcare professionals seeking a four year certification as a case manager.

Additional Resources

“Reducing disparities in health care”. AMA. Access here

“Racial Inequities Persist in Health Care Despite Expanded Insurance”. Roni Caryn Rabin.  August 17th, 2021. New York Times. Access here

“Health Inequity in the Time of a Pandemic”. Madelyn Valu. October 9th, 2020. HIMSS. Access here

“Health Equity — Are We Finally on the Edge of a New Frontier?”. Michele Evans, MD. September 10th, 2020. The New England Journal of Medicine. Access here

Certified Case Manager: Starting Their Own Business

Posted on by Dominick Flarey

By – James M. Katz, BA

As a certified case manager, starting a business from home can be a great way to achieve financial independence and enjoy the flexibility of working from your own space. You have the unique opportunity to provide specialized services to clients that may not be available elsewhere. With the right planning, you can develop a successful home-based business that meets the needs of your clients and generates an income. In this guide, we’ll provide you with tips and strategies to get started on your journey as a certified case manager working from home. We’ll discuss the importance of setting up a solid business plan, what you need to consider when setting up your workspace and how to market your services effectively. As a certified case manager, you’ll have the opportunity to make a real difference in people’s lives – and with the right preparation, you can make your home-based business a success.

As seen in the article below, becoming a certified case manager sometimes isn’t enough. Starting your own case management business is the next logical step. However, without the proper strategies in place it can be a treacherous one! You not only need to take care of your patients but you need to run your own business as well.

“Case management is a specialized field of health care that focuses on coordinating services and resources to improve patient outcomes. It involves assessing a patient’s needs, developing a plan of care, and providing follow-up support. An independent case management business provides these services to clients in the private sector, such as hospitals, health care providers, insurance companies, and other organizations.

Starting an independent case management business can be a rewarding endeavor, offering the opportunity to work with a variety of clients and make a difference in the lives of patients. However, it does require extensive research, planning, and preparation. This guide provides an overview of the necessary steps to get started and outlines the key considerations for successful business operations.

“

Access Full Article Here 

Commentary:

Button that says Private Practice Certified Case Manager

Benefits of Starting a Home-Based Business as a Certified Case Manager

If you love working with people and helping them through their challenges, then starting a home-based business as a certified case manager might be a great option for you. It’s a great way to help people in need while earning a steady income that lets you set your own schedule. If you want to travel the world, start a family or simply pursue a different career path, this is an ideal way to do so. There are a number of benefits associated with becoming a certified case manager. One of the most significant is the ability to help people who might not otherwise have access to quality services. You can use your business to help clients obtain benefits, file for Social Security disability, receive Medicaid/Medicare and more.

Setting Up a Solid Business Plan

Every home-based business starts with setting up a solid plan. This includes examining your case management goals and examining what it will take to achieve them. You’ll need to examine what it will take to make the business successful, both from a financial and a personal growth perspective. This will help you determine how much time and energy you should devote to your business. You’ll also need to examine your skills and determine what kind of clients you’re most suited to work with. Ideally, you should be working with clients who have similar challenges to your own clients so that you can provide them with the most value possible.

Establishing Your Home Workspace

The first step in starting a home-based business is setting up your workspace. This includes selecting a professional space that meets your needs and acquiring all of the necessary equipment. A professional workspace will help you maintain client confidentiality and improve your efficiency. It’s important to establish your home workspace before diving into marketing your services. This will help you avoid wasting time and energy on areas that don’t directly impact the success of your business.

Marketing Your Services Effectively

If you want to succeed as a home-based business, you need to understand how to market your services effectively. This will help you find new clients and grow your business over time. It’s important to understand that marketing is an ongoing process. You can’t simply sit back and expect clients to find you. You need to be creative and use a variety of methods to reach potential clients. Some of the most effective marketing strategies include networking with other certified case managers, networking with your professional association, blogging about your services and adding value to online communities.

Tips for Staying Productive and Organized

If you want to stay productive and organized as you start a home-based business, you need to be intentional with your time. This means knowing when you’re taking on more than you’re able to handle and avoiding multitasking. It’s important to create a schedule that addresses your responsibilities and activities. This schedule should include both work and personal commitments. If you don’t have a schedule that includes both work and personal commitments, you’ll be overwhelmed with the demand placed on you.

Networking Opportunities for Certified Case Managers

Networking is an important part of marketing your services. This is especially true if you’re just starting out as a home-based business. Networking provides you with opportunities to meet potential clients in a relaxed setting and discuss your services. This can help you identify potential clients and build your network of professional connections. Networking can be challenging if you don’t know where to start. Networking opportunities can help you overcome this challenge. Some of the best networking opportunities include attending professional association meetings, participating in online communities and attending networking events related to your industry.

Conclusion

There are many reasons why people choose to start a home-based business. One of the most common reasons is to earn more money. While it is important for you to earn more money through your home-based business, it’s also important to enjoy what you’re doing. You don’t want to become so consumed by your home-based business that you no longer have time to pursue interests, friends and family. If you find yourself in this situation, it’s important to take a break and reassess your priorities. There are many benefits associated with becoming a certified case manager. One of the most significant is the ability to help people who might not otherwise have access to quality services.

A healthcare certification can open the door to new career opportunities. With a profession as vast as healthcare, it is easy to specialize yourself. Nursing and other healthcare professionals have dozens of different fields they can go into and explore, increasing their value. If you are interested in becoming a certified Case Manager, you should visit our Case Management Certification Page Here.  

References:

Wikipedia Case Management Page – 

CDC Case Management Page – 

Additional Resources:

Applying Project Management Methods to the Creation of a Start-up Business Plan: The Case of Blendlee, Jolita Kiznyte, et al, PM World Journal. Vol. V, Issue ZV – May 2016
Access Here – 

Making a business plan for starting a transitional pain service within the US healthcare system, Sun EC, Mariano ER, Narouze S, et al Regional Anesthesia & Pain Medicine 2021;46:727-731.
Access Here – 

Advanced Practice Nurses: Developing A Business Plan for an Independent Ambulatory Clinical Practice Johnson, Joyce E Johnson, et al. Pitman Vol. 35, Iss. 3, (May/Jun 2017): 126-133,141.
Access Here – 

The relationship of personality traits and entrepreneurship tendencies with career adaptability of nursing students, Oznur Ispir, et al. Nurse Education Today Volume 79, August 2019, Pages 41-47
Access Here – 

 

Telehealth and Substance Abuse

Posted on by Dominick Flarey

Since Covid erupted onto the healthcare scene, Telehealth has become a more available option for appointments.  At the peak of the outbreak it was a necessity and continues to hold importance to individuals who have a difficult time getting out to see a doctor.  Many also love the convenience.  Since it was successful, this newer technology can be applied to a wide variety of healthcare and mental healthcare needs.  Substance abuse counseling is a sector that can use its service.  It can keep individuals who are susceptible to addiction find support and guidance.

Telehealth can help counselors help those with substance abuse.

 

The article, “Can Telehealth Help With Addiction Treatment?” by John Loeppky takes a look how this novel and important technology can utilized for those suffering from substance abuse.  He concludes that the values are immense but only if this service can be applied to the population who needs it, whether in rural areas or access.  He calls for a greater push for this service to help individuals facing substance abuse and addiction.  He states,

“Experts say that the changes around telehealth medical appointments could help many with substance misuse disorder, but that many people may not get access to these programs. Dr. Katherine Hirchak (PhD, MHPA) of Washington State University, whose research and work is centered on American Indigenous communities, says that healthcare policymakers and providers need to make sure that they’re not prescribing urban solutions to issues facing rural communities, especially when it comes to internet availability.”

“Can Telehealth Help With Addiction Treatment? John Loeppky. January 29th, 2023.  Healthline.

To review the entire article, please click here

Commentary

The technology revolution has changed the way we live our lives, the way we work, and the way we access healthcare. It has made it easier for us to access health care services from the comfort of our own homes, and it has made it possible for us to access specialized care that may not have been available in our locality. One of the most significant changes it has brought about is in the way we access substance abuse treatment. In this blog, we will discuss telehealth and how it is revolutionizing substance abuse treatment.

What is Telehealth?

Telehealth is a form of remote healthcare delivery that uses technology to provide medical care, mental health services, and other health-related services. It is a great way to provide healthcare services to people in remote locations or those who are not able to access traditional healthcare services. It is also an effective way to provide care to those who have mobility issues or other special needs.

Telehealth services can include video conferencing, phone calls, emails, and text messages. It is a way for healthcare providers to stay connected with their patients and to provide timely and efficient care.

Telehealth and Substance Abuse Treatment

Telehealth can provide an amazing service for substance abuse practitioners to help their clients with addiction and mental health

 

Telehealth has become an increasingly popular option for substance abuse treatment. It has allowed treatment providers to reach a broader range of patients who may not have been able to access traditional services. It has allowed providers to offer more personalized care and to tailor treatment plans to the individual needs of each patient.

Telehealth is also a great way for substance abuse treatment providers to monitor the progress of their patients. They can use video conferencing to observe patients’ behavior and to provide feedback and guidance. They can also use text messaging and email to stay connected with their patients and to provide reminders and encouragement.

Benefits of Telehealth for Substance Abuse Treatment

One of the greatest benefits of telehealth for substance abuse treatment is its convenience. It eliminates the need for patients to travel to a treatment center and can be accessed from anywhere with an internet connection. This makes it easier for patients to access treatment and to stay connected with their providers.

Telehealth also allows for more personalized care. Providers can use video conferencing to observe their patients and to tailor treatment plans to their individual needs. They can also use video conferencing to provide feedback and guidance to their patients.

Telehealth also makes it easier for substance abuse treatment providers to collaborate with other healthcare providers. Providers can use video conferencing to consult with other providers and to discuss treatment plans. This allows them to provide the best possible care to their patients.

Finally, telehealth allows for more cost-effective care. It eliminates the need for patients to travel to a treatment center and can be accessed from a variety of devices, including smartphones and tablets. This can help reduce the cost of care and make it more accessible to those who may not be able to afford traditional treatment services.

Challenges of Telehealth for Substance Abuse Treatment

While telehealth has many advantages in the treatment of substance abuse, there are also some challenges that need to be addressed. For example, telehealth services may not be available in all areas, and there may be limitations on what services can be provided. Additionally, telehealth services may be difficult to access for those in rural areas who do not have access to reliable internet or mobile phone services.

Another challenge is that telehealth services may not be as effective as traditional face-to-face treatment services. This is because it may be difficult for the provider to observe changes in behavior and to provide feedback and guidance. Additionally, there may be limitations on how much information can be shared and discussed over video conferencing.

Finally, there may be a lack of privacy and security with telehealth services. This is because the services may be provided over public networks, which can be vulnerable to security breaches. Additionally, there may be a lack of regulation in some areas, which can lead to a lack of oversight and accountability.

Telehealth and Mental Health Services

Telehealth is also being used for mental health services, such as counseling and therapy. It is a great way for providers to stay connected with their patients and to provide timely and efficient care. Additionally, it can be used to provide services to those in remote locations or those who are not able to access traditional services.

However, there are some challenges with telehealth for mental health services. For example, it may be difficult to establish trust and rapport with a patient over video conferencing. Additionally, there may be technical issues and delays, which can make it difficult for the provider to provide effective care.

Telehealth and Evidence-Based Practices

Evidence-based practices are an important part of substance abuse treatment. They are strategies and interventions that have been proven to be effective in the treatment of substance abuse. Telehealth can be used to provide evidence-based services, such as cognitive-behavioral therapy and motivational interviewing.

Telehealth can also be used to provide other evidence-based services, such as medication-assisted treatment and relapse prevention. It can be used to provide education and support for patients, as well as to monitor their progress and provide feedback and guidance.

Telehealth and Accessibility

One of the greatest benefits of telehealth is its accessibility. It eliminates the need for patients to travel to a treatment center and can be accessed from anywhere with an internet connection. This makes it easier for patients to access treatment and to stay connected with their providers.

Additionally, telehealth can be used to provide services to those in remote locations or those who are not able to access traditional services. It can also be used to provide services to those who have mobility issues or other special needs.

Finally, telehealth can be used to provide services to those who cannot afford traditional treatment services. It can be a more cost-effective option and can make treatment more accessible to those who may not be able to afford traditional services.

Telehealth and Cost Effectiveness

Telehealth can also be a more cost-effective option for substance abuse treatment. It eliminates the need for patients to travel to a treatment center and can be accessed from a variety of devices, including smartphones and tablets. This can help reduce the cost of care and make it more accessible to those who may not be able to afford traditional treatment services.

Additionally, telehealth can be used to provide more cost-effective services to those who cannot afford traditional services. For example, telehealth can be used to provide counseling services to those who cannot afford weekly visits to a therapist. It can also be used to provide medication-assisted treatment to those who cannot afford inpatient or residential treatment programs.

Conclusion

Please review AIHCP’s Substance Abuse Practitioner Certification Program and see if it meets your academic and professional goals

 

Telehealth is revolutionizing the way we access substance abuse treatment. It is a great way for providers to stay connected with their patients and to provide timely and efficient care. It also allows for more personalized care and can be used to provide evidence-based services. Additionally, it can be used to provide services to those in remote locations or those who are not able to access traditional services. Finally, it can be a more cost-effective option and can make treatment more accessible to those who may not be able to afford traditional services.

The technology revolution has changed the way we access healthcare, and telehealth is revolutionizing substance abuse treatment. It is an effective and cost-effective way to provide care to those who may not have been able to access traditional services and can help improve the quality of care provided to those in need.

If you or someone you know is struggling with substance abuse, telehealth may be an option worth exploring. It is a great way to access the care you need and to stay connected with your provider. It is also a great way to access evidence-based services and to get the help you need to recover from substance abuse.

Telehealth is revolutionizing substance abuse treatment and is a breakthrough in counseling. It is an effective and cost-effective way to provide care to those in need and is a great way to access the help you need.

Please also review AIHCP’s Substance Abuse Practitioner Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in substance abuse counseling.

 

Additional Resources

“Telehealth: Technology meets health care”. Mayo Clinic.  June 18th, 2022.  Mayo Clinic.  Access here

“Telehealth: What Is It, How to Prepare, Is It Covered?”. National Institute on Aging.  Access here

“Telehealth: The advantages and disadvantages”.  Stephanie Watson. October 12th, 2020.  Harvard Health Publishing. Access here

“Tele-treatment for substance use disorders”. December 7th, 2022. TELEHEALTH.HHS.GOV.  Access here

Nurse Case Managers: Benefits of Continuing Education

Posted on by Dominick Flarey

By – James M. Katz, BA

The demand for qualified Nurse Case Managers has been increasing in recent years, as healthcare organizations become more focused on providing quality care to patients. In order to stay ahead of the competition and remain current on the latest health care trends and practices, it is essential for Nurse Case Managers to invest in continuing education. Continuing education provides Nurse Case Managers with the skills and knowledge to effectively manage and improve patient outcomes It also helps to increase job satisfaction. It can build their confidence and strengthen their reputation within the healthcare industry. Investing in professional development is essential for Nurse Case Managers, as it helps to enhance their skills, stay up-to-date with the latest industry trends, and remain competitive.

Nurse Case Manager Smiling

Continuing education and further training can not only help you stay up to date with modern trends but it can also keep you competitive to any potential health care employers. Showing evidence of training highlights and showcases your commitment to providing the best healthcare to your patients and a willingness to adapt to new concepts. In the article below it details other important aspects of continuing education in nurse case management.

“Continuing education (CE) is one of the most important things a nurse can do. CE allows nurses to stay current on the latest advances in their field, find new ways to care for patients, and learn about new technologies. We’ll explore some of the benefits of CE for nurses and explain why it’s such an important part of your career.

The Importance of Continuing Education

Providing nurses with continuing education opportunities strengthens the nursing profession. It keeps nurses up-to-date on the latest techniques and knowledge. Continuing education can also help nurses stay competitive in the job market, as they can demonstrate their expertise and skills to potential employers. In fact, according to a study by RTN, almost half of all employers say that continuing education is one of the key reasons they hire a new nurse.”

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Commentary:

What is Continuing Education?

Continuing education is defined as an organized program of educational instruction. It’s usually intended to advance a person’s professional development. Continuing education is offered both online and in-person, and is frequently used to describe any classes and workshops that are not required for a person’s academic degree. For Nurse Case Managers, continuing education can include attending conferences, webinars and seminars hosted by healthcare organizations or other industry experts. It can also include taking part in mentorship programs or serving as a mentor to others in the field. Continuing education can provide Nurse Case Managers with a wide array of benefits, including increased knowledge and skills, improved job satisfaction and a strengthened professional reputation within the industry.

Benefits of Continuing Education for Nurse Case Managers

There are numerous benefits associated with continuing education for Nurse Case Managers. Some of the most significant benefits include improved patient outcomes, increased job satisfaction and strengthened professional reputation. One of the most significant benefits of continuing education is improved patient outcomes. By gaining a better understanding of the latest health trends and practices, Nurse Case Managers can provide high-quality care to patients and improve their outcomes. These can directly contribute to the bottom line of healthcare organizations. Another significant benefit of continuing education is increased job satisfaction. By investing in professional development, Nurse Case Managers can gain a better understanding of their role within the organization, which can lead to more job satisfaction. Additionally, through the skills and knowledge gained from professional development, Nurse Case Managers can be more effective in their role, which can lead to more job satisfaction.

Strengthened Professional Reputation

As the demand for health care services continues to grow, the need for qualified Nurse Case Managers also increases. There are a limited number of Nurse Case Managers in the healthcare industry, which has led to a high demand for this role. Due to limited supply and high demand, Nurse Case Managers often have the ability to negotiate higher salaries, receive more job offers, and have the opportunity to select from the best healthcare organizations. As the demand for Nurse Case Managers continues to increase, organizations are looking for highly qualified candidates. In order to meet the selection criteria of organizations and be selected for the role, it is essential for Nurse Case Managers to continue investing in professional development. By continuously gaining new skills and knowledge, Nurse Case Managers can make themselves more attractive to healthcare organizations and strengthen their reputation as an industry expert.

How to Invest in Professional Development

In order to make the most of continuing education, it is essential for Nurse Case Managers to choose the right learning opportunities. It is important to select classes and workshops that pertain to the job responsibilities of Nurse Case Managers This is so that they can apply their new skills in the workplace. It’s also recommended that Nurse Case Managers participate in mentorship programs or become mentors to others in the industry. Mentorship programs can provide important insights and guidance to Nurse Case Managers, while also helping others to advance their careers. To make the most of continuing education, Nurse Case Managers can follow these three steps:

– Research the latest industry trends: By researching the latest trends in the healthcare industry, Nurse Case Managers can identify areas of interest, as well as determine which topics are most relevant to their job responsibilities.

– Identify learning opportunities: After selecting the topics of interest, it is essential to identify the best learning opportunities to help advance knowledge and skills in those areas.

– Make the most of continuing education: Once the best learning opportunities have been identified, it is essential to make the most of continuing education to advance knowledge and skills.

Conclusion

As the demand for healthcare services continues to grow, the need for qualified Nurse Case Managers also increases. To remain competitive in the healthcare industry and advance in their careers, it is essential for Nurse Case Managers to continue investing in professional development. There are a variety of benefits associated with continuing education, including improved patient outcomes, increased job satisfaction and a strengthened professional reputation. By following these three steps, Nurse Case Managers can make the most of continuing education and advance their careers.

Nursing Case Management is a growing field with plenty of potential employers looking for highly qualified recruits. If you are a nursing professional looking to enter the case management field or if you need continuing education training then perhaps you should consider our Case Management Fellowship program? For more information please go here.

References:

Center of Disease Control and Prevention –

Wikipedia: Continuing Medical Education – 

Additional Resources:

Continuing Education; Lifelong Learning. Marjan Laal, Et al. Procedia – Social and Behavioral Sciences, Volume 116, 2014, Pages 4052-4056, ISSN 1877-0428,

Access Here  

Educational benefits for nurses and nursing students of the dementia supporter training program in Japan. Matsuda Y, Et al. (2018) PLoS ONE 13(7): e0200586.

Access Here 

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. Clive Ballard , Et al. Published: February 6, 2018.

Access Here

Perceived Benefits of Pre-Clinical Simulation-based Training on Clinical Learning Outcomes among Omani Undergraduate Nursing Students. Madhavanprabhakaran G, Et al Sultan Qaboos Univ Med J. 2015 Feb;15(1):e105-11. Epub 2015 Jan 21. PMID: 25685368; PMCID: PMC4318589.

Access Here 

The Use of Technology in Diabetes Care Management

Posted on by Dominick Flarey

By – James M. Katz, BA

Diabetes is one of the leading causes of death worldwide, but with the increasing presence of technology in our lives, it has become much easier to manage this chronic disease. Technology has revolutionized diabetes care management and is helping people with diabetes to monitor, analyze, and adjust their health. Smartphones, wearable devices, and apps enable people with diabetes to track their blood sugar levels, exercise, nutrition, and medications. With the help of technology, diabetes management can be done more accurately and efficiently, allowing them to live a healthier and more productive life. Additionally, technology has enabled doctors and healthcare managers to provide better quality healthcare to their patients by quickly and accurately diagnosing any issues and making adjustments to their treatment plans. Technology is also providing new treatments and therapies that can help people with diabetes better manage their condition. In short, technology is transforming diabetes care management, providing new opportunities to lead a better, healthier life.

The article linked below goes into further detail on the emerging use of new technologies in diabetes healthcare management. It looks in-depth at the use of insulin delivery systems, blood sugar monitoring devices, as well as other health care management apps. For more please read the quote below and press the link.

“The revised standards, issued this week, include a section devoted to technology, including continuous glucose monitoring (CGM) devices that allow people living with diabetes to check their blood glucose levels at any time, automated insulin delivery systems and digital health tools that offer coaching and access to resources.

The guidelines recommend that anyone living with diabetes have access to FDA-approved technology to manage their chronic condition, especially seniors and underserved populations. The ADA also points out that technology can be used to improve access to care and care management for those dealing with health inequity, or barriers to care caused by social determinants of health.“

WHY TECHNOLOGY IS INTEGRAL TO DIABETES CARE MANAGEMENT Health Leaders Media  BY ERIC WICKLUND  DECEMBER 14, 2022

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An infograph about diabetes care management

Commentary:

Overview of Diabetes

Diabetes is a condition in which the level of sugar in the blood is too high. There are two main types of diabetes: Type 1 diabetes, which usually appears in childhood or adolescence, and Type 2 diabetes, which usually appears in adulthood. In Type 1 diabetes, the pancreas does not produce enough insulin, which is a hormone that helps break down the food we eat and turn it into energy. In Type 2 diabetes, the pancreas makes enough insulin, but the body cannot use it properly. In both conditions, a person’s blood sugar level rises above normal, and they need to take steps to lower it. People with diabetes often also experience other health issues like cardiovascular disease, kidney disease, and eye disease.

What is Diabetes Care Management?

Diabetes care management refers to the process of managing diabetes and achieving optimal blood sugar levels to prevent complications. In recent years, there has been a growing focus on improving the quality of diabetes care management, with an aim to prevent the development of complications and reduce healthcare costs. Technology is playing a significant role in improving the quality of diabetes care management. Through the use of wearable devices, smartphone apps, and telehealth technologies, people with diabetes are better able to track their blood sugar levels, exercise, nutrition, and medications. Doctors, healthcare providers, and technology are working together to provide better quality healthcare management, enabling clinicians to quickly and accurately diagnose issues and make adjustments to their treatment plans to improve patient outcomes. Additionally, technology is helping people with diabetes better manage their condition and achieve better health outcomes, allowing them to live a healthier and more productive life.

How Technology is Revolutionizing Diabetes Care Management

Wearable Devices – Wearable devices such as blood glucose monitors, activity trackers, and sleep trackers can be used to track a person’s blood sugar levels, daily activity, and sleep quality. These devices can send data to a smartphone app and can also be programmed to send alerts when a blood glucose level is too low or a food or medication is scheduled to be taken. Smartphone Apps – Diabetes apps are available in a variety of forms, including lifestyle apps, social networks, blood glucose tracking apps, and medication reminder apps. Lifestyle apps can help people with diabetes track and improve their nutrition, sleep, and activity levels. Social networks allow people with diabetes to connect with each other and receive support and encouragement. Blood glucose tracking apps allow users to track their blood glucose levels throughout the day and receive alerts when the levels are too low or too high. Medication reminder apps can help people remember when to take their medications and make adjustments when the time is incorrect. These apps are designed to improve the quality of diabetes healthcare management by enabling people to track their blood sugar levels, exercise, and medication intake more accurately and efficiently.

Telemedicine

Telemedicine is the use of information technology to provide medical care remotely. This technology is revolutionizing diabetes healthcare management by providing remote monitoring of blood glucose levels and medication adherence. In addition, remote monitoring enables patients and providers to detect health issues at an earlier stage and make appropriate adjustments to treatment plans to prevent complications. Remote monitoring also provides access to care for people who might not otherwise have access to physicians and diabetes management specialists.

Benefits of Technology in Diabetes Care Management

– Improved Compliance with Treatment Regimens – Technology can help patients adhere to their treatment regimens, which is essential for managing diabetes. When patients forget to take their medications or take them at the wrong times, their blood sugar levels are likely to increase and they are at a higher risk of developing complications. With the help of technology, patients can easily and accurately track when they took their medications and can receive alerts when they forgot to take them. – Improved Quality of Life – Technology is also revolutionizing diabetes care management by improving the quality of life of people with diabetes. It can help people track their blood sugar levels, exercise, and nutrition to a greater extent than they are able-bodied. Additionally, technology can help people with diabetes stay connected with others and feel less isolated. – Real-Time Data Accessibility – Another benefit of technology in diabetes care management is its ability to provide real-time data accessibility. Real-time data access allows people with diabetes to track their blood sugar levels and adjust their food intake or medication dosage if needed. Real-time data access also allows doctors and healthcare providers to track their patient data and make adjustments to their treatment plans as needed.

New Treatments and Therapies for Diabetes

Blood Glucose-Sensing Injectables – New blood glucose-sensing injectables are revolutionizing diabetes care management by delivering insulin directly to the bloodstream through a small, painless needle. This can help prevent low blood sugar during periods of exercise or after eating a meal. Artificial Pancreas – An artificial pancreas is a device that analyzes a person’s blood glucose levels, insulin levels, and food intake to determine the right amount of insulin required to keep blood glucose levels within a healthy range. This device automatically delivers insulin to the bloodstream, allowing people with diabetes to live a more normal life. Gene Therapy – Gene therapy is a new treatment that aims to stop the progression of Type 2 diabetes. In this treatment, a virus is injected into the bloodstream, where it travels to the liver and inserts a gene that produces insulin-producing proteins. This therapy aims to halt the progression of Type 2 Diabetes by controlling blood glucose levels and allowing people with diabetes to live a healthier, more normal life.

Conclusion

Diabetes is a serious and growing concern, but technology is revolutionizing the way it is managed and treated. Wearable devices, smartphone apps, and telehealth technologies are helping people with diabetes track their blood sugar levels, daily activity, and medication intake more accurately and efficiently to enable better diabetes care management. Additionally, technology is helping doctors and healthcare providers provide better quality care, enabling them to quickly and accurately diagnose issues and make adjustments to their treatment plans to improve patient outcomes. New treatments and therapies for diabetes are providing hope for people with the condition, enabling them to live a healthier, more productive life.

Diabetes and other health conditions require dedicated healthcare management professionals. Keeping up to date with the latest trends and technology is paramount to giving patients the best care they deserve. If you are in the care management field and would like to add to your education, you should visit our Healthcare Management certification program by pressing here.

References:

American Diabetes Association

Mayo Clinic Diabetes Overview

Additional Resources:

Smartphone-Based Technology in Diabetes Management. Doupis, J., Festas, G., Tsilivigos, C. et al.  Diabetes Ther 11, 607–619 (2020).

Access Here 

Psychology, technology, and diabetes management. Gonder-Frederick, L. A., et al American Psychologist, 71(7), 577–589. (2016).

Access Here 

A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support. Greenwood DA, et al.  Journal of Diabetes Science and Technology. 2017;11(5):1015-1027. doi:

Access Here 

Active Care Management Supported by Home Telemonitoring in Veterans With Type 2 Diabetes: The DiaTel randomized controlled trial. Roslyn A. Stone, et al. Diabetes Care 1 March 2010; 33 (3): 478–484.

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Exploring the Benefits of Case Management in Long-Term Care Today ‍

Posted on by Dominick Flarey
By: Dominick L. Flarey, Ph.D, RN-BC, ANP-BC, NEA-BC, FACHE
       Board Certified, Adult Nurse Practitioner
       Board Certified, Nurse Executive Advanced
       Fellow, The American College of Health Care Executives

Photo of a collection of words related to the topic of Long Term Care

In today’s health care system, case management is becoming an increasingly important way to ensure quality care for long-term health care patients. Case management is a process that involves a team of health care professionals, who work together to coordinate and provide comprehensive care for patients with long-term health care needs. This team of professionals is responsible for assessing a patient’s medical needs, developing a care plan, and monitoring the patient’s progress. Case management has numerous benefits, from reducing hospitalizations and emergency room visits to improving overall quality of life. It also helps to reduce costs, as case managers can ensure that patients receive the most appropriate and cost-effective care. By exploring the benefits of case management in long-term health care, we can better understand how it can help improve patient outcomes and reduce costs.

What is Case Management?

Case management is a process that involves a team of health care professionals, who work together to coordinate and provide comprehensive care for patients with long-term health care needs. Rather than having health care providers treat specific issues, case managers consider the entire individual and how different aspects of their care are related. This team is responsible for assessing a patient’s medical needs, developing a care plan, and monitoring the patient’s progress. Case management has been used in different areas of healthcare for some time, but in recent years, it has also gained prevalence in long-term care. This type of care typically involves a combination of services, such as nursing, pharmaceutical, social work, and rehabilitation. Long-term care services are generally needed by individuals who have a chronic illness or disability that requires ongoing care.

Long-Term Care

Long-term care is an interdisciplinary field of health care encompassing a range of services and supports for individuals who are chronically ill or have a disability. This type of care is used to provide assistance with activities of daily living such as bathing, dressing, grooming, and eating, as well as instrumental activities like housekeeping, shopping, and managing finances. Long-term care can be provided at home or in other settings such as adult day programs, assisted living facilities and nursing homes.

Benefits of Case Management

Case management has numerous benefits, from reducing hospitalizations and emergency room visits to improving overall quality of life. In exploring the benefits of case management in long term care today, it also helps to reduce costs, as case managers can ensure that patients receive the most appropriate and cost-effective care. By exploring the benefits of case management in long-term health care, we can better understand how it can help improve patient outcomes and reduce costs: 1). Reduced Hospitalizations and Emergency Room Visits, when patients receive coordinated and comprehensive care, they may spend less time in the hospital, as well as in the ER. This is particularly true for patients with chronic illnesses and/or long-term care patients. 2). Ensures greater quality of care, due to the interdisciplinary approach of case management, patients are often provided with more thorough care. This can help to ensure that each aspect of the patient’s care is addressed, which can ultimately improve overall quality of life. 3). Case Management in Long-Term Health Care, one of the primary ways in which case management is used in long-term health care is to help provide an ongoing assessment of a patient’s care, as well as their needs. 4). Provides for a more collaborate approach to long-term care delivery, long-term health care has traditionally been managed by physicians, who have been responsible for both diagnosis and treatment. With the implementation of case management, however, other types of health care professionals, such as nurses and social workers, are also able to provide care. This helps to provide a more interdisciplinary, collaborative approach to long-term care delivery.

Helps to improve patient outcomes

index card on table that is written on it Long Term Care with a blue stethoscope laid around it and a red heart and a pair of eyeglasses laying next to the index care

Case Management is also known as care coordination and/or care management. When individuals in long-term care are involved in case management, there is a potential for improvement in their overall health outcomes. Patients in long-term care who participate in case management are more likely to receive the medical care and services that they need. This could include medications, nutrition therapy, or specialized therapies such as physical therapy. People in long-term care who receive the services that they need may experience better outcomes in terms of their mental health. This may include a reduction in feelings of depression, anxiety, and/or feelings of isolation. People in long-term care who receive the services that they need may experience better outcomes in terms of their ability to live independently. This may include a reduction in the amount of assistance needed to perform daily living tasks, such as bathing or eating.

 

Challenges of Case Management

While case management offers many benefits, it is important to note that it is not a cure-all for the challenges that exist in today’s long-term health care system. One challenge is that not every patient who needs long-term care has access to it. Although long-term health care is becoming increasingly common, there are still not enough resources available to meet current needs. There is also not enough consistency in the services offered throughout the long-term health care system, as there are many different types of providers, who offer long-term care. This means that patients and families may not receive the same level of care from one provider as another. Another challenge of case management is that it is not always the best option for all patients. While it can be beneficial, it is not appropriate for everyone. This can make it more challenging to identify patients who will benefit from case management services.

Conclusion

Case management is a growing trend in long-term health care, as it offers numerous benefits and helps to improve outcomes. Although it is not a cure-all, it can help to improve the quality of care patients receive and reduce costs. While challenges remain, case management remains a promising way to improve long-term health care.

Education and Certification in Case Management

Are you a registered nurse, social worker or a health care professional who is interested in case management? If so, the American Academy of Case Management offers a unique, online curriculum of core courses that leads to a full Certification and Fellowship Status in the Academy. You may access this link for full information on the program. Courses are continuing education courses with Board approvals and may be taken one course at a time until completion. All of the courses are online with faculty mentoring as needed and there are no travel requirements. Any questions may be addresses to: info@aihcp.org

Suggested Readings

1. Can post-exposure prophylaxis for COVID-19 be considered as an outbreak response strategy in long-term care hospitals? Sun Hee Lee, et.al. International Journal of Antimicrobial Agents. Vol. 55(6): June 2020. access here.

2. Case management in capitated long-term care. Rick T. Zadwaski, Catherine Eng. Health Care Finance Review. National Library of Medicine. December 1988. access here.

3. What Does “Managed Long Term Care Service” Mean in the United States? A Concept Analysis From a Case Manager’s Perspective. Kyungmi,Woo, et.al. Home Health Care Management & Practice. Vol.33(3):November 7, 2020. access here.

4. What do we (still) need to know about long-term care management? Howard B. Degenholtz. Generations Journal. American Society on Aging. Spring 2021. access here

 

 

The Benefits of Telehealth in Patient Care Management Today

Posted on by Joseph Gerard

Doctor Talking To Patient Through Video Chat On LaptopWritten By: Dominick L. Flarey, Ph.D., RN-BC, NEA-BC, FACHE

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely. It can be used to provide real-time clinical services to patients in remote locations, as well as to store and share medical data. Telehealth  has the potential to improve access to care, quality of care, and patient outcomes.

In recent years, there has been a dramatic increase in the popularity of telehealth services. This trend is likely due to a variety of factors, including the increasing accessibility of high-speed Internet and mobile technologies, the rising cost of healthcare, and the growing demand for convenient and accessible healthcare services. Telehealth allows patients to consult with their healthcare providers from the comfort of their own homes, which can be a more convenient and affordable option than traditional in-person appointments.

Telehealth Care Benefits for Care Management

The use of telehealth in patient care  is on the rise due to its many benefits. Telehealth allows patients to consult with their doctors from the comfort of their own homes, which is especially beneficial for those with chronic illnesses or mobility issues. It also saves time and money by eliminating the need for travel to and from appointments. In addition, telehealth can improve communication between patients and their care providers, leading to better overall health outcomes.

Despite its many advantages, there are some challenges associated with telehealth. For example, not all medical conditions can be effectively treated via teleconference. In addition, there may be technical difficulties that can impede the quality of the consultation. Nonetheless, telehealth is a promising solution that can improve patient care in a number of ways.

There are many benefits to telehealth, including increased access to care, improved patient outcomes, and cost savings. Telehealth can improve access to care by providing care to patients in rural or underserved areas. Additionally, telehealth can improve patient outcomes by providing timely and convenient care. Finally, telehealth can save money by reducing the need for travel for appointments and reducing the length of hospital stays.

 

Ease of Access to Health Care Management

The use of telehealth has improved access to care for patients by providing them with more convenient and affordable options. Telehealth allows patients to connect with their care providers from any location, which can be especially helpful for those who live in rural areas or who have difficulty accessing transportation. In addition, telehealth services are often less expensive than traditional in-person visits, which can make them more affordable for patients.

Telehealth is the use of digital information and telecommunications technologies to support long-distance clinical health care and patient care. By using telehealth, medical providers can more easily and conveniently provide care to patients who may not be able to come into the office for an appointment. This is especially beneficial for patients who live in rural areas or who have difficulty traveling. Additionally, telehealth can be used to provide follow-up care or consultations, which can help improve patient outcomes.

 

3D illustration of computer keyboard with the script "Telehealth" on pale blue button. Remote service concept.Compliance to Health Care Management

The increased comfort for patients using telehealth is due to the ability to consult with a medical professional from the comfort of their own home. This reduces stress and anxiety related to seeking medical care in-person, which can be particularly beneficial for those with chronic conditions or mental health concerns. In addition, telehealth appointments are typically shorter than in-person visits, which can also contribute to patients’ increased comfort levels.

There is evidence to suggest that the use of telehealth can help to reduce the number of missed appointments among patients. This is likely due to the fact that telehealth can help to improve communication between patients and their care providers, and can also provide patients with greater flexibility in terms of when and how they receive care.

The ease of patient care for patients who live far away from health care centers of providers has greatly increased due to the implementation of telehealth services. Through the use of video conferencing, patients are able to consult with their doctors or specialists from the comfort of their own homes. This increases accessibility to medical care and decreases the need for travel, which can be difficult for those with chronic health conditions.

Telehealth also allows for more timely appointments and shorter waiting times. This is beneficial for both the patient and the provider, as it reduces the overall time spent on each case. In addition, telehealth appointments can be scheduled outside of normal working hours, making it easier for patients who have difficulty taking time off work or school. Overall, telehealth has had a positive impact on patient care by increasing access to medical services and reducing wait times.

 

Cost Reduction and Improved Outcomes

The use of telehealth services can help reduce the overall costs for patients. This is due to the fact that telehealth services can help to improve communication between patients and their healthcare providers. In addition, telehealth services can also help to improve access to care for patients. By using telehealth services, patients can avoid having to travel to see their healthcare provider. This can help to save time and money for patients.

The use of telehealth can result in improved patient outcomes. This is because telehealth provides patients with access to care that they would otherwise not have. Additionally, telehealth can help to improve communication between patients and providers, and can provide patients with education and support.

 

Case Management by Telehealth

Telehealth has been shown to be an effective means of providing case management services, particularly for patients who live in rural or underserved areas. Certified case managers can provide a wide range of services via telehealth, including assessment, care planning, coordination, and advocacy. This type of care delivery can help to ensure that patients receive the comprehensive care they need, while also reducing travel time and costs associated with traditional in-person visits.

The use of technology in case management for in home care telehealth by nurse case managers is essential to providing quality care. Technology allows nurse case managers to keep track of their patients’ progress, schedule appointments, and communicate with other members of the healthcare team. In addition, technology can help nurse case managers educate their patients about their condition and treatment options.

The use of video conferencing by nurse case managers allows for real-time interaction with patients and families, which can be beneficial in a number of ways. First, it enables the nurse to build rapport and trust with the patient, which is essential for providing effective care. Additionally, it allows the nurse to gather information about the patient’s condition and needs in a way that is more efficient and convenient than traditional in-person visits.

Nurse case managers are using innovative technologies today to communicate with other team members. These technologies include electronic medical records, computerized provider order entry systems, and electronic prescribing systems. By using these technologies, nurse case managers can more effectively coordinate care for their patients and realize the benefits of telehealth in practice.

 

Conclusion

In conclusion, telehealth is a valuable tool that can improve patient care in a number of ways. By providing patients with convenient access to care, telehealth can help to improve health outcomes and reduce healthcare costs. In addition, telehealth can also help to increase patient satisfaction by providing them with more control over their own care.

Most all specialty practice in health care today are using telehealth in care delivery. This is seen even more frequently in the specialty practice of Case Management by professional Registered Nurses and professional Licensed Social Workers. The advent of more expanded technologies in patient care has allowed the practice of case management to significantly expand in recent years bringing significant benefits of telehealth to patients and to the health care team. The American Academy of Case Management offers a comprehensive continuing education and case management certification program for those who are practicing health care professionals. Professionals have a period of two years in which to complete the program but may accelerate if they wish. To learn more about the program, you may access here.

 

Additional Readings

Telehealth Benefits and Barriers. S. Garjarawala, N. Pelkowski. The Journal for Nurse Practitioners. Vol 17, Issue 2: 2021. Access here

Increasing Access to Care: telehealth during Covid-19. D. Hoffman. Journal of Law and the Biosciences. Vol 7, Issue 1: 2020. Access here 

Strategies for Evaluating Telehealth. J. Chuo, et.al. Pediatrics. Vol. 146. Issue 5: 2020. Access here

On-Demand Synchronous Audio Video Telemedicine Visits are Cost Effective. G. Nord, et.al. The American Journal of Emergency Medicine. Vol 37. Issue 5: 2019. Access here

 

Case Management In- Home Care Technology Offers Patients Comprehensive Support

Posted on by Joseph Gerard

Case Management graphicWritten by: Dominick L. Flarey, Ph.D, RN-BC, NEA-BC, FACHE

As the population of older adults continues to grow, so does the demand for home care services. Case management  is a critical component of home care, as it helps to ensure that patients receive the coordinated care they need to improve their health outcomes.

Case managers work with patients and their families to develop a care plan that meets their specific needs. They also coordinate home care with other providers, such as home health aides, nurses, and doctors. This coordinated approach ensures that patients receive the best possible care. The goal of home care case management is to provide high-quality, cost-effective care that is in the best interest of the patient and their family.

Monitoring patients’ progress is an important part of case management in home care. By tracking patients’ health status and response to treatment, case managers can identify potential problems early on and take steps to address them.

Regular monitoring also allows case managers to evaluate the effectiveness of care plans and make necessary adjustments. This is especially important in home care, where patients may have complex needs and be receiving care from multiple providers. By closely monitoring their patients’ progress, home care case managers can play a vital role in ensuring that they receive the high-quality, coordinated care they need to improve their health outcomes.

 

Types of Technology

Over the past decade, information and wireless technology companies, senior long-term care entities and colleges and universities have developed and offer a line of products aimed at supporting professional home health care services and family caregiving.

Information technology applications and programs provide accounting and billing services and medical recordkeeping for home health care providers and biometrics, emergency phone calls, live customer services, medical alerts for patients and social activities coordination for seniors and their caregiving families.

Home health care is a rapidly growing industry, and technology plays an important role in providing care for patients. There are many different types of technology available to help home health care providers, including software that helps with scheduling and accounting, communication tools, and medical devices. Technology can help home health care providers provide better care for their patients, and it can also help patients stay connected to their loved ones and receive the support they need.

One of the most important advances in patient care technology is the ability to monitor heart function at home. This can be done through wearable devices that track heart rate and rhythm, or by using devices that measure electrical activity in the heart (ECG). These devices can help detect arrhythmias or other problems with heart function early on, before they become serious.

The home care technology market is growing rapidly as the demand for patient support services increases. Billing, medical records, food service ordering, and patient communications are all areas where home care technology can play a role.

Billing systems that allow patients to pay their bills online or through a mobile app are becoming more popular. Medical records systems that give patients access to their health information from a secure website or app are also gaining popularity. Food service ordering systems that allow patients to order their meals from a mobile app or website are becoming more common. And patient communication systems that allow patients to stay in touch with their care team via text, email, or video chat are becoming more prevalent.

According to the FCC, “an effective emergency alert system (EAS) can save lives and property by providing timely and accurate information about an impending hazard.” Emergency medical alert devices and systems are life-saving tools that can be used in the event of a medical emergency. These devices can be worn as a pendant or bracelet, and they can be connected to your home’s landline or cellular phone.

When activated, these devices will send a signal to the monitoring center, which will then dispatch emergency medical services (EMS). The monitoring center will also contact your loved ones or designated caregivers to let them know that you have requested help.

As a certified case manager, you are responsible for ensuring that your patients receive the best possible care. To do this, you must be well-informed about the technology used in home care today. Patient care technology has come a long way in recent years, and it is constantly evolving. As a case manager, it is your responsibility to stay up-to-date on the latest trends and developments. This will help you make sure that your patients are getting the best possible care.

Hospital admissions are costly and stressful for both patients and their families. By staying up-to-date on the latest patient care technology, you can help reduce hospital admissions and re-admissions. This will improve the overall  quality of care for your patients and save money for patients and the health care system.

 

heart monitor graphicSome Companies Providing Advanced Technologies

The following companies, applications and programs have been touted by researchers and experts in the senior care industry and government policymakers and lawmakers:

  • Acumen–In the last 23 years, this Mesa, Ariz.-based company provides financial management services for senior short-term care and long-term care facilities, states, counties and managed care organizations nationally, including billing, enrollment, and payment processing, reporting and training.

 

  • AT & T and Numera Libris–Both companies collaborate to blend wireless technology by AT & T with traditional emergency response systems by Numera to form comprehensive medical support for seniors with chronic conditions or transitioning from hospital care to skilled nursing or home health care. The result is meant to address personal safety and home health management. Called a “personal health gateway,” the system combines mobile emergency response, two-way voice, fall detection and location tracking.

 

  • Critical Signal Technologies (CST)–This Pittsfield, Mass. and Farmington Hills, Mich. Company provides a suite of personal emergency and medical monitoring services that assist patients with dizziness, falling, mobility issues, muscle weakness and vision problems. CST provides adaptive switches for quadriplegia, care transition and vital sign monitoring, cellular upgrades, coaching, door/window contacts, lock box, medication management, motion detector, multi-lingual response with fall down detection, multi-tenant coverage, pillow switch to summon help, reminder messaging, sensor mats, smoke or carbon monoxide alarm, standard personal response system, strobe lights and wall communicators.

 

  • CASOA–CASOA, which stands for The Community Assessment Survey for Older Adults, is a research survey program specializing in needs and preferences assessments of seniors offered by the National Research Center, Inc., a national survey research and evaluation firm based in Boulder, Colo. The program is meant to assist local governments, area agencies on aging, homeowners associations, senior short-term care and long-term care facilities and service providers to develop their social and medical programs for seniors.

 

  • Hamilton CapTel–This is a free, nationwide, telephone captioning service meant to make phone calls simple, clear and accessible for individuals with hearing loss. The company supplies phones with the captioning service in an app product that is compatible with and can be used with PCs, MacBook’s, iPhone, Android, BlackBerry smartphones, iPad and Android tablets.

 

  • iHealthHome–The Seattle-based company provides in-home monitoring and communications systems to enable care coordinators, family caregivers, home health care agencies, and; senior long-term and short-care facilities, including assisted living, congregate care and nursing homes. Services include assessments, biometrics, care management, communication between seniors and their caregiving families, in-home concierge system to order food and medicine by computer, medication management, messages for caregiver tasks, motion activity monitoring for safety, questionnaires, remote supervision, time and attendance tracking and video visits.

 

  • Intel-GE Care Innovations–The resulting personal response system is the result of a partnership between Intel, the computer chip company, and General Electric, the electrical services and government defense contractor. The suite includes a personal help button, emergency assistance, home base, medical alerts and 24-hour live response operators.

 

  • Panasonic HomeTeam–Panasonic, based in Newark, N.J., and Osaka, Japan, has developed an online service called HomeTeam meant to serve homebound seniors and their family caregivers that uses a video chat app for a tablet, laptop and computer to access interactive books such as Curious George and games such as chess and checkers with video calling. The app can be downloaded by grandparents and their grandchildren from the Apple App Store or Google Play and can be used with Androids or iPads. The company works with publishers such as Houghton Mifflin Harcourt Publishing company, Disney and game developers to maintain children’s games and games on the company website.

 

  • SilverTreeHealth–This Chandler, Ariz.-based company provides integrated electronic health reporting and automated medical billing services that includes coding experts, software and efficiency controls. Service includes user-friendly interface, a boost of HIPAA compliance for senior long-term care facilities and other service providers; claim scrubbing; electronic resubmission of claims; payroll cost reductions; missed visit tracking; staff embezzlement reduction; accounting program integration; e-Eligibility; free live support; live, free upgrades; hourly backups; secure direct payments to bank accounts; real-time integration with thousands of insurance carriers; complete practice visibility; claims management tools; insurance practice profiling; accurate claim coding and tracking of contracted rates; patient scoring to determine likelihood to pay; scheduling of integration with billing processes; ePrescribe and eClaims; integrated credit card processing; experienced billing staff, and; weekly reviews of practice efficiencies.

Whether they specialize in billing, biometrics, emergency alerts, fall prevention, patient care monitoring, family ties or medical records management, these aforementioned products are meant to contribute to a comprehensive suite of solutions for families who cannot fulfill certain necessary tasks in caring for seniors and need outside technical intervention.

 

Summary

In recent years, nurse case managers have been increasingly managing in-home patients using care technology within more sophisticated health care delivery systems. This shift has been driven by a number of factors, including the increasing prevalence of chronic conditions, the aging population, and the rise of consumer-driven health care.

Care technology has played a major role in enabling nurse case managers to more effectively manage in-home patients. By providing real-time data on patients’ condition and allowing for two-way communication between patient and provider, care technology has helped to improve patient outcomes and satisfaction while reducing costs.

As health care delivery systems continue to evolve, it is likely that nurse case managers will play an even greater role in managing in-home patients using care technology. This trend represents a major opportunity for nurses to impact the quality and cost of health care delivery.

 

Case Management Certification

Are you a registered nurse or a health care professional interested in pursuing a career in Case Management? The American Academy of Case Management offers a full curriculum of continuing education courses in case management as well as a national Certification Program. To find out more about our programs, access here.

Additional Resources:

  1. Why Home Healthcare Needs More Technology and Training. Jessica Longly. HealthTech. October 29, 2020. Access here

From Facility to Home: How Health Care Could Shift by 2025. Oleg Bestsennyy, et.al. McKinsey & Company. February 1, 2022. Access here