Care Management of Medicaid/Medicare

Question 1

How many people have chronic conditions?

Answer 1

1/4 of all Americans of 2+

3/4 elderly have multiple

Question 2

What is clinical effectiveness or efficacy?

Answer 2

Effectiveness–in the real world may not make a difference b/c of social factors etc.
Efficacy–ideal setting, research proven

Question 3

What are some social determinants of health?

Answer 3

poverty
low levels of literacy
limited English proficiency
minimal social support
poor living conditions
limited community resources

Question 4

What are some considerations in managing multi-morbidities?

Answer 4

patient preferences
guideline limitations
shared decisions
balanced actions
patient welfare
disease severity & consequences
parismonious care

Question 5

Who can be a care manager?

Answer 5

RN
social worker
pharmacist
behavioral health specialist
dietitian
nutritionist
non-clinical staff

Question 6

What is a comorbidity v. multimorbidity?

Answer 6

co–related to same central process

multi–unrelated, but often clump together for patients

Question 7

What are some key elements of case management?

Answer 7

healthy behavior promotion
health literacy
informed participant
collaboration w/ pt, family, providers
appropriate use of resources

Question 8

What is utilization management?

Answer 8

manage services & resources
ex: don’t prescribe antibiotics for viral illnesses!
track patients radiation exposure after tons of imaging.

Question 9

What are some things that a care management organization will provide?

Answer 9

enrolle services
provider services
administrative services