Case management has five essential features: (1) identifying all those affected by the disease that are eligible for a case manager, (2) assessing current levels of healthcare and needs of eligible participants, (3) developing an individual care plan for each participant, (4) putting the care plan into action, and (5) monitoring of results. In addition, Case management can be delivered as a single intervention or as part of a multicomponent intervention (e.g., disease management).On the other hand, Network Health offers integrated case management program. Network Health’s integrated case management program offers a holistic, multi-disciplinary approach to managing health care services for members with complex care needs such as patient with diabetes. The integrated case management program consists of medical, behavioral health, and social care management clinicians, physicians, pharmacists, and community outreach staff. These groups work together to provide a wide range of services to members including, but not limited to, intensive clinical management and utilization management aftercare. Network Health partners with more than 20,000 primary care providers, specialists, hospitals, and community organizations statewide. Facilities Network Health is contracting with nursing facility or rehabilitation facility, hospitals, clinics, outpatient care to provide care to patients with diabetes and other patients with chronic conditions. Network Health only credentials professionally competent providers and facilities who continually meet their qualifications, standards, and requirements. This is to ensure that these providers give the members quality care consistent with recognized managed care organization industry standards. Older adults with diabetes residing in the long term-facilities represent the most vulnerable. In addition, Managed Care Organizations should contract only with those facilities that meet the plan’s (and implicitly the plan members’) needs for pleasant surroundings, even if there may be a better price elsewhere. For example, the facility might ensure that the plan’s members are given a private room or are placed in a room with a patient with a similar functional status, and in a section of the facility that has a clean and pleasant environment. (Kongstvedt, 2007, p. 144) Quality of Care Managed Care plays a significant role in the overall strategy of quality improvement. There are three criteria developed by Avvedias Donabedian for the assessment of quality of care: structure, process, and outcome. Structural measures of health care performance focus on the context in which care and services are provided. These measures provide inferences about the managed care organization’s (MCO’s) capability to provide the services it proposes to offer. Examples of structural measures include board certification of physicians, licensure of facilities, compliance with safety codes, record keeping, and physician network appointments (Kongstvedt, 2007, p. 336). Network Health requires health care providers/facilities to submit supporting documents such as current valid license and current and valid accreditation to make sure that competent providers and facilities meet their qualifications, standards, and requirements. Process Measures evaluate the way in which care is provided. The IOM aims for improvement in process measures focus on safe, effective, timely, patient-centered, efficient, and equitable health care. Examples of care process measures for MCOs include the number of referrals made out-of-network, preventive health screening rates (eg, mammography and cholesterol screening), follow-up rates for abnormal diagnostic results, and assessment of adherence to clinical algorithms for different conditions. (Kongstvedt, 2007, p. 337). In diabetes disease management program, Network Health reminds their members about their lab work and PCP appointments and provides preventive health screening such as hemoglobin HbA1c, lipid, and eye exams. The third criterion for the assessment of quality is outcome. Examples of traditional outcomes measurements include infection rates, morbidity, and mortality (Kongstvedt, 2007, p. 338). Poor health outcomes need careful review and assessment.
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Health information technology plays a crucial role in managing chronic diseases. According to the study, Health Information Technology will play a significant role in transforming primary care practices and chronic disease management. The use of Electronic Health Records and Health Information Technology can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety (Rao, Brammer, Mckethan, &
Health information technology plays a crucial role in managing chronic diseases. According to the study, Health Information Technology will play a significant role in transforming primary care practices and chronic disease management. The use of Electronic Health Records and Health Information Technology can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety (Rao, Brammer, Mckethan, &