Essays on Case Management

Challenges faced by MCOs regarding price variations and ways of overcoming these challenges

Challenges Utilization management acts as one of the most complex financial balancing act that managed care organizations (MCOs) try to utilize in an effort to manage health care costs and create value for future health care services (Bailit & Sennett, 1992). However, managing cost through utilization management concept creates price variations that pose major challenges to MCOs. One of the major challenges faced by MCOs regarding price variation is its diverse nature. The use of utilization management in MCOs has gained a lot of demand making it difficult to make a general conclusion on certain variations. Price variations linked to ...

Health and Hospital Management

Numerous organizations have taken a holistic approach to health and healthcare system management as they seek to address the common problems related to the rising health care costs, need for insurance, and promotion of healthy staff. The organizations have sought to establish and implement health care plans for thousands of employees. The plans have raised the need to have administrative competence, excellence in case management, solid network of care providers and health care institutions and departments. Common health-related problems today require a continuum of care that is built upon the collaboration of several actors and institutions. For this reason, ...

Introduction

After 47 years in business, Dallas-based Tenet Healthcare Corp. (THC) has grown into a network of 79 hospitals, 20 short-stay surgical hospitals, and more than 470 outpatient centers in addition to nine facilities in the United Kingdom. As of 2015, it has 130,000 employees in its healthcare network. Three years ago, it acquired for $4.3 billion the Vanguard Health Systems (VHS) (Jacobson, 2013), which Charles Martin Jr. founded in Nashville, Tennessee in 1997 and has a network of more than 26 healthcare institutions, which are a combination of acute care and specialty hospitals in five states: Illinois (Chicago); ...

(Author Name) (Course Name/Number) The application of best treatment practices is essentially the staple of the social service profession and it is through evidence-based research that social scientists continue to improve the quality of treatment for underserved populations. As individuals and societies present with new and worsening problems, the study of cause-effect and possible solutions becomes an even more interdisciplinary study, involving not only the involvement of research in a theoretical framework, but also dependent largely on the data collected by social work professionals who utilize these theories in application on a daily basis. Because psychology and sociology are ...

Abstract

This paper evaluates several sources to try and determine whether the needs of youth in juvenile detention facilities are being met. While most youths consider counselling to be effective, more than half of them do not have the pleasure of working with professional mental health personnel. The education system used in most of these facilities tends to be ineffective because the needs of detained youth are different from the needs of their counterparts in the general population. Further, there are various disruptions, including court proceedings and security procedures that take up plenty of time that would be used for ...

Criminal Justice Setting: Federal Corrections

Role: Social Worker providing Case Management Services Of the 114 federal prisons existing today, 27 are for females. The average age of the female inmate is 28. 66% of female inmates are white. 18% of female inmates are not citizens of the United States. 28% of female inmates are Latino, and 29% are black. Women in prison serve an average of 78 months. There are currently 13,033 female inmates in federal prison and they include 6.7 % of the federal prison population. Most of these women in federal prison are poor, single mothers who are undereducated and unskilled. Every ...

Citizenship and Instruction Program

Experience and Community Need BronxWorks, is a settlement house and multi-service organization with proven track record of leading immigration services since 1998. That year we first collaborated with SEEDCO to launch a series of initiatives that target low-income immigrants with limited English language proficiency. Our organization leveraged resources to provide English as a Second Language (ESL) services and civics classes from the New York City Department of Youth and Community Development (DYCD) to more than 250 participants in 2015 and over 600 participants since its inception. For over 18 years, we have provided citizenship and ESL instruction to New ...

Quantitative Study

Vamos, E. P. et al. (2012). Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes: retrospective cohort study. British Medical Journal, 1-10. Retrieved from: http://www.bmj. com/conte nt / bmj/345/bmj.e5567.full.pdf

Research Problem and Purpose

Vamos et al. (2012) posit that maintaining a blood pressure of 140/90 mm Hg is recommended for the population diagnosed with hypertension, and an even lower blood pressure of 130/80 mm Hg is recommended for people with chronic conditions such as diabetes and cardiovascular diseases. However, clarity on the effects of the blood pressure on all-cause mortality is currently lacking.

Hypotheses and Research Questions

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The provision of case management services is done within correctional and community environmental in aiding individuals improve their criminal behaviors and conditions. In the current world, criminal activities have become rampant with the increased cases of robbery, murder, and drug abuse. The community perceives violent crime as the most perilous crime as a result of its integral effect on the public. Therefore, the government has initiated measures and mechanisms through which violent crimes can be combated. For instance, community and correctional setting facilities have facilitated in improving the security situation within the country.

Correctional setting involves a coordinated approach of ...

The use of nurse case managers has been done extensively at different levels of care. Carondelet Saint Mary’s Hospital located in Arizona had a project that exemplified the role of a nurse case manager, especially in acute care. In this project, nurse case managers formed partnerships with high-risk patients in acute care. Through these partnerships, the nurse case managers help to reduce the length of stay in hospital. Through collaborations with the physicians in acute care, nurse case managers help reduce the number of clinical services, the number of be days and the length of ...

Question 1

As a result of reforms in health care encapsulated in the Affordable Care Act, health care exchanges that are state or federally run have been established. The establishment of health care exchanges is bound to alter outpatient treatment as a concept in health care. Some of the benefits that those covered under health insurance enjoy include consultation fees paid to doctors including specialists and payment for examinations and tests requisite to the treatment of illnesses (Carey, 2010).

The implementation of health exchanges has organized the market, making it easier for people to purchase insurance. The ...

What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges? Variations in healthcare programs are expensive. Overutilization, underutilization, and improper utilization are challenges that MCOs face. MCOs should adhere to procedures and protocols using the established standards by organizations example the national committee for quality assurance (NCQA).

Differentiate between the three main processes of institutional utilization management

Determine the main purpose of each process of institutional utilization management. Which process do you think is the most important, and why? The direct admissions’ purpose is to create timely attendant for the outpatients that come to the hospitals. ...

HEALTH CARE FINANCING AND ACCESS TO SERVICES

Managing and offering health care to the patients has become among the most controversial and problematic issues in the United States of America presently. The major problem is arising as a result of conflicts between the health care providers and the interests of the patients. The problem entails access to quality health care and cost of the health care. The costs are abnormally high while the quality is substandard, hence resulting to an economy with unhealthy population. Many health care providers have included some high costs on cost of medication. Others like health maintenance organizations have been able to restrict ...

“Case management’’ is understood to have originated from the process of moving cerebral health patients out of the institutional care and into the group of people in the USA and UK in the 1980’s.The word management implies direction and power, that something more happens than would happen by possibility or through the individual’s own initiatives. Any association which deals with cases might be said to practice case management and their approach to it might be called case management approach. Case management process consists of numerous steps or sub-processes that are recurring, iterative and recursive rather ...

Introduction

Plainfield is a city in the New Jersey with a population of 46,318 and a population density of 7690 people per square kilometer. It has over 15180 households and about ten thousand families living in the city. The city is racially diverse with African Americans being the dominant race, accounting for 50 percent of the population (Onboard, 2011).

The white population in Plainfield is 23 percent, Native Americans account for 0.91 percent, 0.05 percent of the population are Pacific islanders and 0.95 percent are other races. Children account for 35 percent of the population while married population account for 37.9 percent. ...

1. The sentinel is a new information and case management file developed to integrate the components of commercial (Hite, 2007).

The Sentinel was intended to provide an electronic management, management of the work flow, management of the evidence, repotting capabilities, search and the sharing of information with other law enforcers and the intelligence at the community level by the FBI (Hite, 2007).

This is primarily intended to improve the FBI capabilities by adopting the use of electronic system in information sharing rather than the paper-based system of reporting. The sentinel therefore provides support to the FBI priorities with the key ...

Beginnings

Family of Woodstock began in 1969 as the Woodstock music festival was occurring in Upper State New York (Burger). The organization’s principle founder, Gail Varsi, realized that all of the people coming into the area needed help. A majority of the people was young and was in need of shelter, food, and clothing. Varsi used her home phone line as Family of Woodstock’s crisis line and turned her home into a shelter (Burger). Some of the people needed more than just shelter, food or clothing. There was also a need for transportation, counseling and rehabilitation. It was not uncommon ...

Amongst mentally ill patients at high risk for early readmission, does the utilization of a multi-component transition care plan as compared to usual care help to improve early readmission rates?

Abstract

The early hospital readmission rate in a 30-bed psychiatric unit in California is 25%. This figure is higher than the 13% reported in the literature for high-income countries like the US (Vigod et al., 2013). Early readmissions are problematic as they are costly and disruptive to the personal and professional lives of patients and their family members. In addition, they are construed to be negative patient outcomes and negative indicators of ...

Jane is the case management coordinator for a large public teaching hospital, and she is responsible for all case management and discharge planning for admitted patients and directs activities through a number of case managers and social workers. Therefore, in order for Jane to assist her case managers better coordinate the work of the different professional, she needs to come up with strategies that favor them this entails use of strategies like the democratic leadership, team work and the strategy of communication. Democratic leadership strategy will ensure that each member is able to contribute to the running of the firm, and ...

Chronic Obstructive Pulmonary Disease (COPD) as a health condition that makes it difficult to inhale and exhale which has resulted in many deaths as noted by the Center for Disease Control (CDC). As the fourth cause of deaths among Americans resulting from long-term inhalation of pollutants, it is imperative to develop a long term management plan, establish standards and best practices that can lead to effective and efficient managing of the situation, and establish clinical standards based on evidence-based practice regarding the management of the health challenge

Developing overall case management plan

In developing the overall case management plan, it is relevant to factor in some ...

Assignment 1: CHCAOD408B and CHCAOD411A

Assignment 1: CHCAOD408B and CHCAOD411A 1. What are you required to discuss with a client prior to an assessment? Although the exact sequence for preparing a client for an assessment might vary across different organisations, the personal/organisational introduction should always be the first step because it allows us to engage in small talk, establish rapport, and it makes the client feel comfortable. However, in addition to establishing rapport, this phase of the meeting also serves for the purpose of observing the client’s reactions and behaviours. Examples of presenting behaviours in clients with a history of alcohol or other drug ( ...

Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence) Tumberculosis (TB) is a communicable chronic granulomatous disease caused by Mycobacterium tuberculosis. It primarily affects lungs; it may affect any organ or tissue of the body. Typically, the centres of tubercular granulomas undergo caseous necrosis. It is “spread through inhaling tiny droplets from the coughs or sneezes of an infected person”. Typically, its symptoms include; persistent cough for more than three weeks, in which the phlegm maybe bloody; weight loss; night sweats; high temperature; tiredness and fatigue; ...

Introduction A case management plan entails different aspects. These aspects need to integrate cohesively in order to achieve the over goal of the case management plan. In managing chronic obstructive pulmonary disease, case management is very vital. This is because it is not only incurable but also chronic. In developing a case management plan, it is important to incorporate three vital components. These components include best practices in the management of the disease condition, published guidelines pertaining to the management of chronic obstructive pulmonary disease and the clinical pathways. This paper ventilates on these components as it relates to the ...

Discussion Replies 2

Hi Wanda, your discussion forum is detailed in that it explores various perspectives. I agree with your discovery that even though continuum of care is defined differently in different settings, there is a confluence of goals and objectives. I also agree with your point that the lack of integration and cooperation among service providers is a big impediment to the continuum of care. This also relates to the differences in business objectives and care objectives, and the fact that business objectives might gain precedence over care objectives (Finkelman, 2011). The use of social workers and case managers are ways that my ...

Introduction

COPD is an acronym for chronic obstructive pulmonary disease. This is a progressive disease which affects one’s lungs, rendering it increasingly difficult to breathe. The term progressive in the definition of chronic obstructive pulmonary disease implies that the disease increases in severity over time. Chronic obstructive pulmonary disease causes coughing in affected individuals and is characterized by copious amounts of mucus, shortness of breath, wheezing and tightness of the chest among other symptoms (National Heart, Lung and Blood Institute. 2013). This paper delves in this population, with an aim of studying chronic obstructive pulmonary disease. The paper will ...

Discussion Replies

Reply to Julie I agree with your argument that case managers have to ensure that evidence based practices are used in the management of patients, that the patients should be at appropriate levels of care and that all activities in case management should be backed by documentation. In your post, you identify several areas where the input of a case manager is required. Your arguments, especially with these areas relate to the importance of continued care for the patients in order to ensure that the plan outcomes are achieved. It is for this reason that nurse case managers continue ...

According to White & Hall (2006), nursing case management is special in the sense that it is a dynamic and follows a systematic approach that offer health care services to a particular population. The framework of nursing case management is composed of five parts including planning, assessment, evaluation, implementation and interaction (While & Hall, 2006). The nursing case management has broadened role of nurses since they are expected to perform patient identification and case selection, data collection and analysis, identification of resources, monitoring, coordination, and evaluation of care. It is vital that the nurse case managers to be able to identify and facilitate the ...

Research carried out by professionals for the World Health Organisation suggested that in the year 2000, a portion of the world population estimated to be 2.8% live with diabetes. Further analysis of the outcome brought an alarming discovery that showed the number of people with diabetes is estimated to double by the year 2030. One of the major reason for the increase of the number of people with diabetes was estimated to be the increased aged population by the year 2030 (Oster, 2011). This disease is related mostly to the feeding habit of people, and this explains the higher number ...

Reason for Discharge [If the client is transferring to case management services at another

Agency, in addition to the Reason for Discharge, include the new agency address and new I am feeling health, and in better shape since the day I joined the program. I would like to terminate the services of the program because I no longer require the services provided here; as I am healthier.

Diagnosis on date of discharge:

Axis I: Axis II: Axis III: Axis IV: Axis V Medication on date of discharge and plan for continuing prescriptions: Presenting situation as described by client at admission to case management program: Goals achieved: I feel I have ...

Diabetes mellitus is a metabolic disorder prevalent globally. It can lead to serious complications if left untreated and unmanaged. The individualized case management programs exist in the hospitals and community settings. These programs direct the patient for managing diabetes with controlled diet, exercise and insulin. The case management programs for diabetes encompass best practices, published guidelines and clinical pathways so that the patient may benefit maximally.

Best practices

Best practices in any disease management program are derived from the repeated practices/procedures that lead to best outcomes. These are evidence-based practices recommended by healthcare practitioners so that the patient may receive the best ...

According to Hadley & Harris (2014), the Internal Revenue Service (IRS) issued supplementary final and temporary regulations that can be found in T.D. 9657 under the Foreign Account Tax Compliance Act of 2009, or “FATCA”, including new regulations that can be found in T.D. 9658. These new rules and regulations have modified the international withholding, as well as the backup withholding and the rules on reporting of information which are applicable beyond the scope of FATCA (Hadley & Harris, 2014). As a general rule under the FATCA, the American withholding agents are mandated to withhold tax on specific payments to the ...

MANAGEMENT OF ASCITES IN MALE ADULT PATIENTS WITH LIVER CIRRHOSIS

(Name of Student)

For the Degree of

(DEGREE) (NAME OF SCHOOL)

ABSTRACT Ascites, the most common liver cirrhosis complication, affected approximately 85% of liver cirrhosis patients in the United States in the last 10 years. The development of ascites signifies an important landmark in the disorder that is associated with a 50% mortality rate (Gines, Quintero, Arroyo, Teres et al, 1987). It also indicates a need for liver transplantation as a surgical treatment. In UK, the true incidence and prevalence of ascites may be unknown, but its mortality has rate has increased to 12.7/100000 from 6/100000 (Fisher, Hanson, Phillips et al 1993-2000). The ...

Studies conducted in many areas relating to healthcare challenges and the proposals and recommendations made. The essence of studies and research is to come up with findings and solutions to problems encountered. It also improves the ways and methods used currently to enhance efficiency in the provision of services. In some occasions, such plans have failed to be implemented and resulting to wastage of ideas and solutions noted from the research. The main reason noted as a cause for such failures is failing to plan and incorporate the plans in the implementation faces of the research done. As the adage ...

Introduction

Developmental social work and developmental social welfare are concepts that have featured prominently on the global scene. Developmental social work is an approach that emphasizes on the roles of professional practice and social investment. It is these social investments that fulfill the material needs of the clients of social work. Additionally, the social investments facilitate the integration of social workers in to the economic and social life of the community. Theorists believe that developmental social workers perceive the strengths and capabilities of their clients to be amplified by the public services and resources (Midgley & Conley, 2010). In their ...

Introduction

According to Travis, Solomon and Waul (1), federal and state prisons release an estimated 600,000 prisoners annually; this transforms to about 1,600 individuals in a day. They find ways of living in harmony with the new community; this is a gradual transition from prison to community life. The transition is not smooth in most cases; the freed prisoners experience difficulties in adjusting. It occurs in terms of; finding employment, adjusting to family life, and society in general (Gaynes, 8). The amount of time spent behind bars leaves most people unprepared for the life outside. If not helped, the prisoners ...

Even though diabetes is a medical condition, its negative effects are observed only in an individual’s physical health. Diabetes also has far-reaching effects on the individual’s social condition, as well as on his or her financial and economic capacities (National Center for Disease Prevention and Health Promotion, 2010). According to the National Center for Disease Prevention and Health Promotion (2010), diabetes has been known to cause blindness among older individuals. Diabetes has been the leading cause of blindness among adults 20-74 years of age (National Center for Disease Prevention and Health Promotion, 2010). Worldwide, diabetes is the ...

Executive Summary

New York City Health Services Clinic or NYHSC is a medical and healthcare clinic located at the heart of one of the busiest cities in the world, New York City. It offers a wide array of medical services from simply primary health care services to more sophisticated premium tertiary healthcare services mainly to New York City residents. NYHSC does not only target those who are already sick because it also offers wellness and disease prevention programs for medically well individuals. Thorough analysis of the health and wellness market indicates that there is an already high and continuously increasing demand for health ...

Ethics

White (2008) states that while a social worker is expected to uphold the interest of his or her client, there are various situations that may challenge this ideal objective. The conflicts of interest may arise when the interest of the social worker interfere with the attention of the needs and interest of the client, whether it may be for personal, financial, occupational, sexual or spiritual motives. The conflict may also take place when the tension arises in upholding the rights of several parties to whom the social worker owes loyalty. The NASW Code mandates the all social workers should be ...

Medicine

Congestive heart failure (CHF) is a chronic disease which is increasing in the United States. On the one hand baby boomers are aging and have become at risk for CHF. People are also living longer. (Ideal, 2009, p. 2) The rate of people under 65 years old entering hospitals for CHF has increased. (Hall, Levant, and DeFrances, 2012, p. 1) In 1900 the number of people over 65 years was approximately 3 million but in 2010 the number is over 34 million; in 2020 the number is predicted to include about 20 percent of the US population. (Quaglietti, Atwood, Ackerman, ...

The least surprising statistical data presented by the Center for Substance Abuse Treatment (CSAT, 1994) was the high prevalence of substance abuse or dependence issues in combination with other mental disorders. According to surveys and research papers from the 1980s and 1990s, substance abuse treatment programs reported between 50 and 75 percent co-occurring mental disorders among their clients while mental healthcare providers reported the prevalence of co-occurring substance abuse disorders among their patients between 20 and 50 percent (as cited in CSAT, 1994). The high prevalence of co-occurring disorders is not surprising because substance abuse causes several changes ...

Introduction

“Children with Special Health Care Needs” (2005) article summarizes the findings of a research developed in Los Angeles County that investigated the children with special health care needs (SHCNs) in the period 2002 – 2003 and the challenges related to their health conditions. A series of interesting findings were reported in this article. In Los Angeles County, in 2002 – 2003, there were 15% of children that required SHCNs, with different racial, ethnical, cultural or income levels. Actually, these categories were found to determine the children’s access to the appropriate treatment. As such, the study found that for Latino population or ...

Catholic Charities are among the largest charities located in the United States. Catholic Charities is a non-profit agency, which was founded in 1910 as the National Conference of Catholic. Catholic Charities is a network of charities whose goal is "to provide service to persons in need, to promote for justice in social structures.” As what is stated on the Catholic Charities main website, in 2008, Catholic Charities agencies served more than 8 million individuals. Catholic Charities received in grants approximately $2.9 billion from the federal government in the year 2010. Comparatively, the organization’s annual revenue was $4.67 billion. Approximately $140 ...

Abstract

The evidence based approach (EBP) to nursing practice provides nurses the ability to deliver quality health care services to a specific population. This kind of approach in the nursing practice is widely used because it reinforces the nurse’s ability to solve problems and overcome barriers using the best evidence available from research, patient references and clinical judgment (Schmidt & Brown, 2011 ). Orthopedic nursing involves the delivery of treatment and management of care to patients with musculoskeletal problems (Lippincott Williams & Wilkins, 2007) and this is one of the areas of clinical nursing practices that impose challenges and difficulties to a clinical nurse. ...

Introduction

Marshfield clinic is non-profit healthcare institution that has been operating for almost one hundred years in the US. The clinic was founded by the six doctors in 1916. The clinic is currently domiciled in Marshfield. The current paper related detailed Quality Management Plan (QMP) and the scope of QMP in Marshfield clinic. It also contains analysis of mission statement and compliance of the goals of Quality Management Plan with mission of the healthcare institution. A significant part of the paper relates principles of Quality Management Plan and reporting of Quality Management Plan activities.

Mission Statement

Mission of Marshfield clinic is to ...

Using Case Management Software and Performance Management Software in Operations

Operations form a critical component of any human service organization. For organizations, that handles a large number of employee personnel having a case management software provides the organization with the ability to enjoy effective running of the organization. Since performance is a key component within the services offered by the organizations, case management software will allow the organization to be able to determine the effectiveness of the presence of humans in the different projects conducted by the organization. In social services, casework is a vital process that gives the organization a sense of purpose. Casework requires the organization to obtain funding and other resources ...

Abstract

Social workers perform a range of services that touch on many disciplines within the greater health and human services field. Case management, which is closely identified with social work, features a skill set that can be applied to many areas within the discipline of social work, ranging from child protection to substance abuse. These skills include problem assessment, treatment formulation, coordination and counseling. There are considerable career development opportunities, and new skill development paradigms provide important resources for professional growth.

Keywords: Social workers, health and human services, case management, child protection, substance abuse

A Career in Health and Human Services

Social ...

Project management software encompasses a range of software solutions to suit the variable need of individuals and groups working on a variety of different types of projects. The software may be used to complete tasks such as: planning and estimates, resource allocation, budget management and cost control, scheduling, quality control and documentation, administration and communication. These various tasks may be addressed by a single software package, individual integrated systems, or stand alone products. “Projects” can be as simple as planning a child’s birthday party to designing a multi-unit residential and commercial real estate complex. Needless to say, there is no one “best.” software ...