Case management for the self-insured hospital.
It is rare for employers who self insure to have on-site case management. Generally, self-insured employers rely on the third-party-plan administrators to control health care costs, provide enrollees with health care benefit management services, and maintain customer satisfaction. In this article, the author discusses the internal workings of an employee case management program implemented in a self-insured hospital in Northwest Indiana. Information is presented on the goals and role of the case manager, scope of practice, barriers to the program, and resources involved to deliver health care services to its enrollees. Also presented is pertinent information to track and trend data for administrative reports. In addition, customer satisfaction and the value of an on-site case manager for self-insured organizations will be addressed. The results demonstrate a reduction in the volume of inpatient admissions, length of stay, and, therefore, an improved use of the health plan.
Dzyacky
S C
SC
Clinical Resource Management/Continuing Care Services, Methodist Hospitals, Gary, Indiana, USA.
D019090:Case Management; D006264:Health Benefit Plans, Employee / Q000458:organization & administration; D006801:Humans; D007196:Indiana; D009937:Organizational Objectives; D017060:Patient Satisfaction; D010564:Personnel, Hospital