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Evaluation of results for each patient & adjustment of the care plan; Evaluation of overall program effectiveness & adjustment of the program [4] In the context of a health insurer or health plan it is defined as: [5] A method of managing the provision of health care to members with high-cost medical conditions.
America's best health plans. Health plan report card. Washington, D.C.: National Committee for Quality Assurance. HEDIS & quality measurement. Washington, D.C.: National Committee for Quality Assurance. The ironic conundrum of the preference sensitive measures, P4P and HEDIS criteria. Disease Management Care Blog, 2009 Mar 8. Dalzell MD.
A care plan includes the following components: assessment, diagnosis, expected outcomes, interventions, rationale and evaluation. [2] According to UK nurse Helen Ballantyne, care plans are a critical aspect of nursing and they are meant to allow standardised, evidence-based holistic care. [2] It is important to draw attention to the difference ...
Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results.
Many IPAs offer management services organization (MSO) amenities including payroll, bookkeeping, benefits management, group purchasing, compliance, marketing, and online reputation management. IPAs may also offer care providers an information technology platform offering automation and/ or a connection to an Electronic Health Record (EHR ...
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The Clinical Care Classification System was developed from a research study conducted by Dr. Virginia K. Saba and a research team through a contract with the Health Care Financing Agency (HCFA), [24] currently known as the Centers for Medicare and Medicaid Services (CMS). The objective was to develop a computerized method for assessing and ...