Integrated Care Management
Defining Terms and Manager Responsibilities
Cartesian Solutions, Inc.™ uses "care management" as a generic overriding
heading for the subtypes of managers and management activities listed in the
table below. While utilization management (UM) is commonly included among other
forms of care management, Cartesian Solutions, Inc.™ places this type
of "management" activity in a separate category, i.e. benefit management. Utilization managers
adjudicate "benefits" not care and work with providers in defining
whether clinical services are covered or meet medical necessity criteria. Care
managers, on the other hand, always partner with the health service use "consumer," i.e.
patient, employee, member, enrollee, etc. in an attempt to overcome barriers
to improvement.
| Types of Care Managers |
- Health care coaches—professionals that assist clients at risk
for complications from health conditions unless a healthy lifestyle is
adopted (also called navigators and wellness counselors)
- Employee assistance counselors—professionals that help employees
address workplace, family, financial, and health issues to maximize
happiness, health, and productivity
- Workers’ compensation managers—professionals
who help insure that employees get the health care support they need
while on workers’ compensation
- Disability managers—professionals
who help insure that employees get the health care support they need
while on disability benefits
- Disease managers—health care professionals
who assist patients get the best care for specific illnesses, e.g.
diabetes, depression,
asthma
- Case managers—health care professionals who assist patients
get the best care when their health complexity creates barriers to
improvement,
e.g. poor diabetes, heart failure, and depression control with complications,
high ER visits, many hospitalizations
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Names Can Be Deceptive
A major problem in the care management industry is that the terms in the
table above, defining various types of management activities and populations
served, are used inconsistently. For purposes of this web site, the terms above will
define subcategories of care management when discussing the value proposition.
Even these, however, are insufficient to understand variations found within
each management category that increase or decrease value brought to the organizations
providing management services or those who purchase them from a management
vendor. In many instances, onsite audits of management activities, as provided
through Cartesian Solutions, Inc.™ services, are necessary to document the
value that they can be expected to bring.
Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com
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