A forerunner in embedded case management, Aetna began placing nurse care coordinators in primary care practices in 2007, buoyed by returns from its telephonic case management efforts. Since then, the payor has clearly demonstrated the value of embedded case managers working side-by-side with physicians serving its Medicare members.
Likewise, several years ago, Bon Secours Health System started embedding case managers within practices, putting them to work as nurse navigators for patients with complex needs or for those experiencing transitions of care.
Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators documents the experiences of Aetna and Bon Secours in the recruitment, education, workload management and IT support of practice-based case managers.
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In this 40-page resource, Dr. Randall Krakauer, Aetna's Medicare medical director, and Irene Zolotorofe, administrative director of clinical operations at Bon Secours Health System, provide a primer on the construction of a co-located case management initiative, sharing lessons learned on the following program concepts:
Recruitment sources and strategies;
Preferred background and skill sets of case managers;
Ensuring the embedded case manager is a fit for the practice, preparing the practice for placement and building a trusting relationship between the case manager and the physician;
- The case manager's role on the physician-led care team;
Training strategies for embedded case managers;
Tools used by case managers, including how to utilize the expertise of each case manager across the continuum;
Typical caseloads of embedded case managers, caseload management strategies and standards of care;
- Benchmarks to evaluate the case managers' effectiveness.
- Healthcare utilization results from Aetna's telephonic case management program, its collaborative case management model and embedded care management;
- How health risk assessments, predictive modeling, prior healthcare utilization and physician referral identify members for case management intervention;
The reimbursement and incentive formula for Aetna's embedded case managers; and
Impact of Aetna's embedded case management on member satisfaction and retention rates.
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