Search results
Results From The WOW.Com Content Network
The amount of involvement an insurer can have in managing high cost cases depends on the structure of the benefit plan. In a tightly managed plan case management may be integral to the benefits program. In less tightly managed plan, participation in a case management program is often voluntary for patients. [5]
The program manager may be well placed to provide this insight by actively seeking out such information from the Project Managers although in large and/or complex projects, a specific role may be required. Program management necessitates consistent progress checks to ensure the projects are matching the portfolio’s direction. These checks ...
Iconographic Collections. Keywords: E. Walker; Florence Nightingale; W.J. Simpson. Health administration, healthcare administration, healthcare management or hospital management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks in all the primary, secondary, and tertiary sectors.
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. [1] [2] PBMs operate inside of integrated healthcare systems (e.g ...
[1] [2] Case management seeks to reduce hospitalizations and support individuals' recovery through an approach that considers each person's overall biopsychosocial needs without making disadvantageous economic costs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing ...
Unwarranted variations in medical practice refer to the differences in care that cannot be explained by the illness/medical need or by patient preferences. The term “unwarranted variations” was first coined by Dr. John Wennberg when he observed small area (geographic) and practice style variations, which were not based on clinical rationale. [5]
A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or visit (homecare).