Certified Case Manager Education: What is Population Health?

Population Health Management

Today’s Certified Case Manager is becoming more involved in assessing and working with information on population health. Population health looks at the data of an entire group instead of an individual patient and considers not only the general state of health of the population but typical outcomes as well.  “Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” (1)

 The term “population health” is a broad one and the group examined can be defined in a variety of ways; your chosen population could be a specific town or city, race or even age group. Viewing data across a broad population can help determine the best practices of care for that particular group and allow for that group’s needs to be anticipated and met. A definition of population health is: “The inherent value of a population health perspective is that it facilitates integration of knowledge across the many factors that influence health and health outcomes.” (1).    “The CDC, which has a Division of Population Health, is far wordier and gives more of a functional definition. Population health is interdisciplinary, according to the CDC website, and an approach that uses “nontraditional partnerships” among different sectors of the community — public health, industry, academia, healthcare, local government entities — to achieve positive health outcomes.” (2)  We see more content being added today to Case Manager Certification education curriculums on this interesting and important practice topic.

William Edwards Deming was a scientist and engineer and is best known for his principles of productivity; his approaches are often modeled by organizations looking to boost efficiency and quality while lowering costs. Deming’s involvement was a key component of Japan’s recovery after WWII; he also brought his unique take on the tie between quality and productivity to corporations in the US, including the Ford Motor company. This attention to quality helped Japan rebound after WWII and become a booming economy just a decade later; it also helped Ford and other US car makers understand why Japanese motors were outperforming homegrown products year after year. Applying these same principles to population health can help improve outcomes and as a natural byproduct of that improved care, reduce costs as well.

 

The Deming Philosophy and Healthcare

The Deming philosophy or approach at its most basic states that when an organization focuses on improving quality, costs will naturally fall over time. Case managers work with this philosophy everyday and are at the forefront of guiding quality, cost-effective care.  Conversely, an organization that is focused on costs will find their quality dwindling over time. This philosophy can be applied to a variety of industries – including healthcare. When we focus on improving care and outcomes, we can expect costs to drop; focus too much on costs and the quality of care can easily slip. Case managers know this well and serve as educators today to teach this to others on the health care team.

 

Applying Deming Principles to Healthcare

Managed Care = Managed Processes

The concept of managed care is less about planning the daily work of individual providers and more about the way that the entire process works. The broad approach that is taken to care will have a larger impact on the health of specific populations; engaging and including physicians and providers in the planning process is a must. These providers are the clinicians dealing with clients on a regular basis, and their insight could hold the key to improved overall process and better levels of care.

 

Engaging Physicians in the Process of Care

Including working physicians in the conversation will greatly improve both the approach to care and the outcomes. Doctors, nurses certified case managers and other providers are working “in the trenches” daily and already have the skills and knowledge to predict what methods will work and what will not. Incorporating frontline care providers in conversations about population health is a must if we are going to properly serve that population and understand what will work (and what won’t).

 

Accurate and Timely Data is a Must

“In God we trust…and all others must bring data.”
William Edwards Deming

This Deming quote is at the heart of why data is so important. If we can’t measure population health data, there is no way to tell if measures are resulting in improved outcomes, worsened outcomes or having no impact at all. The ability to measure and compare data from a specified population is a must; without accurate data and the ability to analyze it, there is no way to determine if measures designed to improve care have any actual impact at all.

The quality-based approach outlined by Deming offers many advantages and possibilities for population health and for healthcare in general.  For true gains to be made, the right data must be collected and accessible, front-line caregivers need to be involved in the planning process, and a broad approach to care for a specific population needs to be implemented. We need to continue to provide continuing education for our case managers and others on the health care team in the quality improvement process, including the use of quality improvement tools, data collection and appropriate interpretation of data.

Some reasons we should care about population health include; 1) it is people focused, 2) it seeks to improve the health of our society, 3) it helps to reduce costs as society becomes healthier, 4) it promotes medical science to deliver better care, 5) it leads to the ability to provide better access to care, and 6) it promotes better patient engagement (3). As such it fits very well into the role of todays certified case manager. It would be most advantageous if we provide our case managers more continuing education and opportunities to become involved in this area of practice. Becoming more intimately involved in population health will assist case management profession in its ultimate growth and expansion of specialized professional practice.

Are you a licensed health care professional who is interested in becoming a Certified Case Manager? If so, you may want to preview information on our Certification and Fellowship program at the American Academy of Case Management. You may access information here.

References:

  1. David A. Kingdig (Ed.) What is Population Health? Improving Population Health: Policy, Practice, Research. University of Wisconsin. Population Health Sciences.
  2. Karen Appold. Confused About Population Health? You’ve Come to the Right Place. Managed Healthcare Executive. Vol. 30, Issue 10. October 2020.
  3. Christina Rosario. Why is Population Health Important? Advanced Data Systems Corporation. July 8, 2020.

Healthcare Case Management Article on Health Insurance Costs

Health Insurance can be expensive.  Families spend millions each year in America on health insurance.

Cost of health insurance for a family is a big concern. Please also review our Healthcare Case Management program

The article, “Here’s how much a family with good health insurance spent last year” Megan Cerullo looks at annual averages for families and how much they pay.

The article states,

“The millions of Americans who have health insurance through their jobs are often viewed as fortunate, shielded from soaring medical costs as well as financial calamity if serious illness strikes. But the cost of those undeniable benefits is climbing—and fast.”

To read the entire article, please click here

Health insurance is a big issue for many families.  It dominates elections and is a pivotal issue.  How much a family pays is a big issue.  Please also review our Healthcare certifications especially in Healthcare Case Management and see if it meets your academic and professional needs.

Legal Nurse Consulting and Nurse Case Management in Worker Compensation

Ethics and law in handling worker compensation cases is a detailed study and professional practice.  Sometimes legal nurse consultants are necessary in understanding the injury and the legal implications of a settlement.  Nurse Case Managers also play an important role in handling the cases and representing the individual case.   Both of these fields, Legal Nurse Consulting and Nurse Case Management play an important role in these outcomes.

Nurse Case Management as well as Legal Nurse Consulting can help cases in workers compensation
Nurse Case Management as well as Legal Nurse Consulting can help cases in workers compensation

The article, “Nursing The Wound: The Law and Ethics of Disability Management in Workers Compensation” by Justin Beck goes into greater detail about this.  The article states,

“Nurse case managers are often viewed with some suspicion by claimants and their lawyers, but a wider perspective is needed to understand the virtues of their profession. In this episode of Workers Comp Matters, host Alan Pierce talks to Justin Beck about his paper, “Nursing The Wound: The Law and Ethics of Disability Management in Workers Compensation.” ‘

To listen and read the entire article, please click here

Please also review our Legal Nurse Consulting Program, as well as our Nurse Case Manager Program and see if they match your academic and professional needs.

 

Healthcare Case Management Program Article on Healthcare

Good article for those interested in healthcare and healthcare related areas.  This article looks at putting health back at the forefront of healthcare and how healthcare professionals can play a pivotal role in making this common sense simple idea work again.  Please also review our Healthcare Case Management Program and see if it matches your academic and professional needs

Please also review our Healthcare Case Management Program and see if it matches your academic and professional needs for certification
Please also review our Healthcare Case Management Program and see if it matches your academic and professional needs for certification

The article, Here’s a Crazy Idea: Put Health at the Center of Health Care, by Clifton Leaf states,

“A decade ago, doctors Tom Frieden and Farzad Mostashari wrote a commentary for a leading medical journal entitled, “Health Care as If Health Mattered.” The essay, published in JAMA (sorry—it’s behind a paywall), had a simple, if obvious, premise: “Health care must be restructured to make maximizing health the organizing principle.”

To read the entire article, please click here

Healthcare Case Management Program Article on Improving Care

Good article on hospital utilization management and reducing re-admissions, denials, and better overall care

Please also review our Healthcare Case Management Program
Please also review our Healthcare Case Management Program

The article, Hospital Utilization Management Can Reduce Denials, Improve Care, source; RevCycle Intelligence states,

“Utilization management in healthcare is commonly thought of as a strategy that payers employ to control resource use within physician offices and hospitals to keep healthcare costs down. However, hospital utilization management programs are also an essential part of a provider organization’s revenue cycle, helping to prevent unnecessary costs and claim denials.”

To read the entire article, please click here

Please also review our Healthcare Case Management Program and see if it matches your academic and professional needs.

Healthcare Case Management Certification Article on Technology and Healthcare

Good article on how technology can help resurrect healthcare.

Please also review our Healthcare Case Management Certification
Please also review our Healthcare Case Management Certification

The article, Can Technology Be The Magic Pill That Cures Health Care?” by Padmanand Warrier  states, 

“As we enter 2018, I’m optimistic that technology will positively impact health care in the years to come. Today, we have the nexus of people power, capital investment and technology innovations to drive that forward. I expect that we’re going to witness history repeat itself and see the Airbnb or Uber of health care emerge.”

To read the entire article, please click here

Please also review our Healthcare Case Management Certification and see if it matches your academic and professional needs.

Case Management Certification Program Article on Small Practice Revenue Cycle

Good article for certified case managers.

Please review our case management certification program
Please review our case management certification program

The article, “3 Pain Points Affecting Small Practice Healthcare Revenue Cycle” by Jacqueline Belliveau states,

“While working in a small practice allows providers to really understand their patients and their community’s healthcare needs, it can also create unique healthcare revenue cycle management challenges.

Small practices come with several advantages. Some providers prefer the close relationship of working with just a couple other physicians versus a multitude of providers in a hospital.”

To read the entire article, please click here

Please also review our case management certification program to learn more.  Please review to see if it matches your academic and professional needs.

Case Management Explains Why Healthcare Costs So Much.

case management
Case Management answer why healthcare costs so much.

The article, “Why is Your Health Insurance So Expensive?”, by  Sandra Mills states

“When we think of insurance, be it homeowner’s insurance, car insurance, or health insurance, we initially think of the accumulative money we’re healthcare 6 going to be dishing out every month.”

American Institute Health Care Professionals‘s insight:
Why is health insurance so high?  This article looks into it with informative graphs and other information that helps someone understand why the price of health care rises.  If you are interested in case management or managed care, then please review the program
#caremanagementprogram

See on www.bhmpc.com

Basic Concepts of Health Insurance

Case Management: Insurance Basics

In many cases, Case Managers have to deal with health insurance companies on an everyday basis in regards to their patients care and coverage.

Below is is health insurance 101 for individuals who need to grasp a better understanding of what health insurance is from the patient end.

Living without health insurance can be risky if you develop a serious illness or undergo trauma, especially if you get an injury or if you get very sick. Having a proper health insurance policy is key to keeping yourself healthy, and these tips can help you get the most coverage for your money.

 

If you are employed by a large enough business, you can get health insurance through your job. If you are 26 or under in age, your parents can still have you under their plan, or you can research personal health insurance policies.

 

Many companies offer benefits for employees to have their health and lifestyles assessed. You may be able to join a fitness program afterwards, which will help the company to save money on their insurance coverage, and possibly lower your premiums.

 

If you need glasses, or vision problems exist in your home, then vision insurance proves a smart buy. The insurance will cover a percentage of your check-ups and eyeglass or contact purchases. You don’t have to carry vision insurance, and some choose to save money by not buying this coverage.

 

Health insurance companies like to change what medications they are willing to cover, so be sure not to enroll in a plan that won’t cover your prescriptions. If medication that you need to take every day is suddenly dropped from your coverage, you may need to find a policy with a different company.

 

Health insurance is great for saving money on your taxes.Any money you spend to cover your deductible, co-pay, or any visits that your insurance doesn’t cover can also be deducted from your taxable income. Be sure to check on the separate guidelines for state and federal tax differences.

 

Expect health insurance policies to have loopholes within the fine print. Read the policy completely, so you won’t be surprised when the company tells you that something isn’t covered.

 

Do not volunteer personal information if you get a phone call from an insurance company. Answer only questions that are directly asked. If you give any extra information, it will be recorded and can be used to raise the premium, or even deny you insurance coverage at all.

 

You need to find out which health insurance plan is best suited for you. You can choose from PPO, HMO or PPO. Each has disparate benefits that you will need to research and decide on before purchasing a policy. Be sure you’ve got the option to keep seeing your current physician.

 

Read over your health insurance coverage to find out which medications are covered by it. The prescriptions that are covered change on a yearly basis, so read it over each time you renew your policy to see what is and isn’t covered.

 

It may actually be more affordable to have separate coverage through your respective employers, so compare costs under both circumstances.

 

The best way to avoid high individual rates is to join a trade organization that provides membership discounts in insurance premiums.

 

Pay very close attention to each aspect of your bills. Even if you have a good health plan, expenses can get costly, particularly for prescriptions. Some doctors only prescribe brand-name medication without thinking if a cheap generic is available. The price of medication may vary between different at each pharmacy.

 

Avoid these issues by taking the time to double check the form.

 

If you are overwhelmed when trying to choose your health insurance, get an insurance broker to help. An insurance broker can assist you in finding the best health insurance at a good price. They will also know all about the regulations specific to your jurisdiction. Compare your prices between brokers before you choose one.

 

You might qualify for a discount card, reducing the cost of your insurance policy as well. These cards let you to see doctors that offer low cost care for those lower income families.

 

If you trust and get along with your current doctor, you will have to make sure that your health insurance policy will permit you to keep seeing him. Ask your doctor if he is currently partnered with any insurance company.

 

Group health insurance is often cheaper than private health insurance, which is why many employers can offer benefits.There are professional groups or associations that you can join like the Freelancers Union.

 

You are entitled to an annual copy of the records at no charge every year for free.

 

Health insurance should be purchased for all family members, but also for your children. You must insure the kids so that they always have the health care as well as illnesses and injuries.

 

It is very important to have health insurance; you never know when you might need it. You could contract a disease or get hit by a car anytime. So utilize these tips when shopping for health insurance to make sure you find the plan that is most suitable for your family at the best price.

If you would like more information on handling insurance as a case manager, then click here.

 

AIHCP

Case Management and Health Insurance

How Can Case Management Help Understand Health Insurance?

A health insurance policy
How can case management explain health insurance do you?
With so many types of health insurance out there, finding one for you and your family might be tough. Ask a case management nurse can be very helpful.   In the case of a medical emergency, that little card can literally be life-saving. This article provides case manager health insurance tips that can benefit you.
Catastrophic health insurance coverage, as explained by case management professionals, is an option for individuals that cannot afford a standard health insurance policy. Catastrophic coverage will protect you in case you experience a severe, life-threatening illness or an unexpected accident of injury. This kind of coverage is also good to add to an overall health care plan as extra coverage when there are extreme circumstances.
Ask your doctor to increase the dose of your prescription to save a few bucks. Often, buying pills in larger doses does not significantly increase the cost so you may be able to save money by cutting the pills in half. This can actually pay for your pill splitter.
A case manager standing by a shelf of files
Nursing case manager sorting files.
Watch your bills, suggests nursing case managers. Even if you have a good health plan, you might get charged for items that will surprise you, such as prescription medication. Some doctors don’t think of generic (and cheaper) versions of medications, and just prescribe the brand name medicine. Don’t hesitate to compare prices as well. The price of the same medication can vary widely at different pharmacies.
The premiums on health insurance are not rigid; consumers can decide what will and will not be part of their benefit plans. For example, you may exclude things like prescription coverage, vision and dental coverage or co-payments on doctor visits. Keep in mind that the more benefits that you chose to have the higher your premium will be and the less benefits the lower your premium.
Health insurance policies often times include different incentives to help you stay healthy. Many health insurance companies now offer discounts on gym memberships, annual medical checkups, quit smoking classes, weigh loss plans, healthy eating classes and annual flu shots. In addition, your premiums may be lowered if you take advantage of these opportunities to save.
If you are qualified, you can get a medical care card at discount, which could give you lower cost insurance coverage from your insurer. This card allows you to go to a doctor in their network that offers reduced cost healthcare for those with low incomes. In some cases, you can even obtain health spending accounts that give you additional ways to take care of your costs.
In the end, it is cheaper if you have a group plan, that is why you have cheaper premiums if you work for someone. The best way to get around this is to become a member or a trade organization that has insurance available to its members.
Raise your deductible to find more affordable premiums for health insurance. If you will increase your deductible, you can significantly lower your health insurance premium. Keep in mind that although your premium will be lower, you must spend more each year before your insurance will pay part of the costs.
If you require health insurance and have are a recent college graduate, there are some things for you to think about. If you’ve got a job, use the employee-based insurance it provides. You can also be listed under your parents’ policy until you turn twenty-six, or look into personal plans.
A health insurance form
A case manager can help you understand your health care.
No matter what, you will save money by buying generics over brand name drugs. Generics are available in most cases and contain the exact same ingredients as a brand name.   Check with a nurse case manager to find out the list of generic drugs you can take.
Check with your health insurance carrier to know what prescriptions are covered under your policy. This list will be different every year or so, so make sure you check it when you enroll again to avoid a surprise at the pharmacy when filling your medication.
The first thing to do is find a suitable company when you apply for health insurance. Another organization is a Preferred Provider,(PPO) which has their own network to pick from; they will allow you choose a doctor from another network, although there is a fee involved. A POP or Point-of-Service plan lets you pick a PCP, but they’re allowed to refer you outside that network.
If issues with your vision have arisen, or if there are hereditary factors that could cause problems in the future, consider an insurance policy that covers vision. The insurance will likely cover some of the cost of doctor visits as well as a portion of costs related to contact lenses and glasses. Insurance for vision is not required, and many people forgo this option to save money.
Are you currently covered under a health insurance policy? Having the right health insurance will ensure that you or your loved ones will receive the care that they need regardless of what situation arises. You can use the advice that this article has provided to you to ensure that you and everyone you love has proper coverage.
By Rick Popovici