Care Recommendations

Practice: review, plan and monitor, eg respect for the value base of care, professional interactions with

Case management services include coordination of health care services with the primary care physician, specialists, and other health care providers to better monitor and provide for a patient’s health care needs. The case managers help to assimilate information about community resources and Kaiser Permanente programs. They also provide disease management when needed. Case managers can assist the patient and their caregivers to understand the patient’s health coverage for medical equipment and services. They also assist with follow-up treatment plans after discharge. These case management services are delivered while maintaining the patient’s privacy, confidentiality, health,

The role of nurse practitioner is valuable when discussing collaborative care. There are so many levels of care, so many health entities, and so many insurer criteria involved that it is instrumental to have a role that can work towards help bring all aspects together. In addition to diagnosing, treating, and managing care, the role of the nurse practitioner is to manage simple and episodic acute health issues along with chronic disease (Sangster-Gormley, Martin-Misener, & Burge, 2013). It is important to note that although this is a function of this role, nurse practitioners also practice from a holistic point of view which allows them to help manage patient conditions or wellness in a more complete fashion. This includes helping patients have access to care beyond primary and secondary care settings. This encourages nurse practitioners to work alongside other health care and allied health professions, and families to create an individualized plan for every patient (van

This will be a cooperative plan with the primary care offices. Patients with chronic illnesses will be referred to care managers if they don’t already have one assigned.

Internal Processes * Qualify for a Patient Centered Medical Home (PCMH) * Communications – (entire staff) – with a quarterly staff meeting * Improve comfort levels with ICD-10 diagnosis coding

There will be information at hand to assist in making medical decision during the time of visit. Lastly, the EHR mandates that people’s health information is to be kept secure ("Department of Health and Human Services," 2008).

ANSWER: The type of information that is gathered is marital status and/or living arrangemet, current employment, occupational history, any use of drugs, alcohol and/or tobacco, level of education, and sexual history. These questions are relevant just incase the lifestyle the patient is living has contributing factors of the patients illness. This will provide more information and can assist in the diagnosis.

Lead Social Worker, Nurse Practitioner, and Clinical Director review record(s) prior to case conference and determine what part of the medical record is appropriate:

The PCP is the main clinician that will be in charge of the patient’s health care delivery.

“Establishing a care plan that meets the patients’ needs and allows for appropriate interventions as symptoms change.” Patient’s without decision making ability comprise a large portion of the long term care population.” Jenna the IDT 
(interdisciplinary team) has to have continuing conversations with the patient’s family or decision maker, to help make decisions. “

Unsuccessful patient transitions of care resulting in negative outcomes is a challenging clinical problem. The perception of a medical condition and how serious it can be can differ from person to person. Adequate education and intervention given at the appropriate time can make all of the difference when it comes to interpreting and receiving a clear understanding of the treatment plan. The consequences of not following a treatment plan properly causes patients to return to the hospital emergency room with complications, which can ultimately result in being readmitted for the same diagnosis. These readmissions, which are virtually preventable, can cost patients and insurance companies

The United States being referred for specialties depends on the insurance plan (Mossialos, Wenzel, Osborn, Sarnak, 2016, pp. 171-177). Health Maintenance Organization (HMO) plans give access to certain healthcare organizations and physician within their network that have agreed to lower rates for their services. The individual must agree to these services to have services covered. All services will be coordinated by the primary care physician PCP. Medicaid coverage is also based on these principles. Preferred Provider Organization (PPO) plan have higher premiums but give more flexibility. PPO allows the individual to see any physician they choose but cost is less if the individual stays within the network. PPO does not require that the individual have a PCP. No referrals for specialist are needed.

Ideally, primary care providers are supposed to look out for your best interest and arrange all your health care needs. In reality, you might be unsatisfied with your PCP, and want to

Case management in the emergency department, constantly works to find the right data in a patient’s record to ensure that they have the correct insurance coverage and can be admitted or discharged at the appropriate time and place. Even when the smallest amount of essential information is not documented, this otherwise straight forward process turns into a scavenger hunt for who has seen the patient, interventions that were done and for what reasons, and at what time all of these things took place. ED case manager Veronica Kountz (personal communication, March 20, 2015) states that the inadequacy of documentation can lead to insurance companies not covering patient costs, which the hospital then has to absorb. Before a patient can be admitted or discharged, the right

Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)