THE EVOLUTION OF CASE MGMT IN REAL LIFE: PART 1: A MEDICARE HEART BYPASS PROJECT PART 2: CASE MGMT AND MEDICAID MANAGED CARE

Course overview

PART 1: A MEDICARE HEART BYPASS PROJECT OBJECTIVES The Case Manager will be able to: 1. Identify the criteria used to select Medicare participating heart bypass centers. 2. Describe the multiple roles of the case manager at St. Joseph's Hospital. 3. Explain the reasons a multidisciplinary team was selected to lead the planning process for the case manager role. 4. Identify the possible improvements when length of stay targets have been achieved for patients undergoing the CABG procedure (DRG 106 or 107). 5. Explain the advantages and disadvantages of the hospital based case manager interacting with the payer OUTLINE A. INTRODUCTION B. MEDICARE HEART BYPASS DEMONSTRATION C. CARE COORDINATION D. THE CASE MANAGER'S ROLE E. EVOLUTION OF THE ROLE Steering Team Case Manager Position Description Education of the Organization Education Needs of the Case Manager Case Manager Responsibilities Obstacles for Implementation PART 2: CASE MANAGEMENT AND MEDICAID MANAGED CARE OBJECTIVES The Case Manager will be able to: 1. Describe the effects on a hospital resulting from transition to a capitated managed care system of reimbursement from a traditional fee-for-service system of reimbursement. 2. Identify the key questions addressed by the Medicaid Managed Care Task Force in its initial exploration of contract bidding. 3. Explain the role of a Medicaid Managed Care Task Force in developing a managed care plan. 4. Describe which broad topic areas were addressed in a hospital's education program OUTLINE A. INTRODUCTION B. MEDICAID MANAGED CARE C. INITIAL EXPLORATION BY HARTFORD HOSPITAL Where are the patients and how many are there? What will the capitation rate be? What can be learned from established Medicaid managed care programs? What process will we use to make the decisions that need to be made and who should be part of the process? What education will the task force need in order to succeed? D. MEDICAID MANAGED CARE TASK FORCE E. CONCLUSION