Acute Care Management
Improving life while reducing risk
The Preferred Care Acute Care Management Program helps improve or optimize identified patients' health status and quality of life. Case management activities are focused on patients with the greatest potential for interventions that will positively impact quality and reduce utilization and/or cost.
Patient Identification and Stratification Process
Patients are identified for possible inclusion in our case management program according to specific criteria, including: targeted diagnoses; utilization and cost triggers; qualitative criteria; and readiness for change:
Diagnosis |
One or more of the following diagnostic triggers are met:
- CVA (stroke), acute rehabilitation, gerontology/frail
elderly, coronary artery disease, transplants,
high-risk pregnancy – prenatal, complex medical conditions such as MS or ALS, catastrophic case management such as placement of ventilator
dependent members or neonates.
|
Utilization |
Utilization criteria are met:
- One or more inpatient admissions or observation stays or two emergency room visits within 90 days
|
Acuity |
Acuity level assessment:
- Identify resources and services required to manage the treatment and outline the duration of treatment
- Determine the need for specialty care management (disease management)
- Determine the likelihood that the patient is amenable to care management (clinical judgment)
|
Additional Indicators |
- Non-compliance with medication or treatment regime
- Poorly controlled chronic disease
- Multiple co-morbidities
- Poly-pharmacy/non-compliance to medication regime
- Impaired neurological status
- Lack of adequate support systems
- Excessive anxiety, fear or depression
- Inadequate community resource support
- Financial difficulties
- Functional decline or ADL impairment
- Frequent ED visits or hospitalizations
|
Interventions
Once the stratification is complete and the patient agrees to participate, an individualized care plan
is developed.
- An initial patient assessment is conducted utilizing clinical guidelines where appropriate and in collaboration with the primary care physician.
- Case managers conduct one-to-one telephonic counseling, home and/or team visits for facility-based patients where appropriate.
- The case managers facilitate and coordinate services across multiple providers and multiple sites to assure progress toward meeting program goals.
Care Managers are Registered Nurses and Social Workers
- Case managers at Preferred Care work in a team model to address the specific clinical issues and the underlying psychosocial concerns that contribute to the overall risk presented by the patient.
- Case managers have diverse clinical backgrounds. Their experience working with community resources enables them to effectively interact with our patients and providers.
How to Get Your Patient Involved
- If you would like additional information about the Acute Care Management Program or would like to refer a member for enrollment, please call the Preferred Care Acute Care Management Enrollment Specialist at (585) 327-2543 or 1-800-933-3920, ext. 2543.
Last updated: October 9, 2006
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