Disease Management VS. Case Management VS. Utilization Management

Disease Management VS. Case Management VS. Utilization Management.
Utilization Management involves a nurse from the insurance carrier approving 'bed days' for a hospitalized plan member.
Case Management involves a nurse from the insurance carrier trying to reduce or stop readmission of plan members that have been discharged from the hospital to 1) Acute Rehab, 2) a Skilled Nursing Facility or 3) a Long-Term Acute Care Facility.
Disease Management involves a nurse from the insurance carrier or disease management vendor working with the patient and his or her doctors and other providers to manage a chronic disease such as 1) Diabetes, 2) COPD, 3) Congestive Heart Failure or 4) Chronic Kidney Disease.
The way VALUE should be measured for Utilization Management vs. Case Management vs. Disease Management is very different and is discussed in detail in the video with examples.
Sources:
www.ajmc.com/v...
cmsa.org/
diseasemanagem...
www.urac.org/a....
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[@jefffrater-lifewithasmirk]

Dr. Bricker: I’ve seen a number of your videos and appreciate you, your service and knowledge. This is the first time I found a number of items to disagree about, either through omission or nuanced difference. But your description of case management sounded very off from what I see first hand and the commonly accepted definition by both the Case Management Society of America and the Commission for Case Management certification: “Case Management is a dynamic process that assesses, plans, implements, coordinates, monitors, and evaluates to improve outcomes, experiences, and value.”
I’ll email my other thoughts which you may choose to highlight in the future.

[@ahealthcarez]

Thank you for sharing your point of view.

[@nalaamour]

Case managers in the hospital settings do interact with patients and families. They go into the rooms and speak with patients to help coordinate their care.

[@ahealthcarez]

Thank you for watching and for your comment.

[@ericklou2013]

Thank you for taking the time to explain this Healthcare concepts. I've worked in Healthcare for quite some time and there is no training or education on explaining these.

[@ahealthcarez]

Thank you for watching and for your feedback.

[@soniaspangenberg8557]

Thankyou, these were very helpful explanations and clarifications.

[@ahealthcarez]

Thank you for your feedback.

[@peachesroyale]

boils down to the money but excellent breakdown

[@ahealthcarez]

Thank you for your comment.

[@grudgerun]

Excellent breakdown, thank you

[@ahealthcarez]

Thank you for watching and for your feedback.

[@15ranvijay]

Beautifully explained but I hope you can include more detailed benefits as an outcome of clinical programs.
As measured in terms of the readmission ratio, PMPM savings, member risk improvement, etc.
You could involve a Risk stratification strategy to cater to the patient population and link to clinical programs to address the gaps in care and involve clinicians in the right care at the right time and the right treatment.

[@ahealthcarez]

Thank you for sharing your thoughts.

[@shivamraja7671]

SO GOOD!!!

[@ahealthcarez]

Appreciate it.

[@vm11169]

Thank you!

[@ahealthcarez]

Thank you for watching.

[@milonnaturalsinaryinbangla5318]

very important video

[@ahealthcarez]

Thank you for your feedback.

[@milonnaturalsinaryinbangla5318]

@@ahealthcarez welcome

[@catherineganley4713]

Your presentation would be much more effective if you slowed down a bit…

[@ahealthcarez]

Thank you for your feedback.

[@asdfaam]

What is care management?

[@jongssscolon]

1:50