Concentrating on the “Super-Utilizers”

Friday, November 15, 2013

 

Many of the initiatives emerging from the Affordable Care Act (ACA) can help case managers address the long-term health of our nation with improved access to care and better preventive care options. However, the patients we deal with on a daily basis can’t wait for benefits to become active, especially patients with the most intensive health care needs who generate the highest costs.

At Medical Management and Rehabilitation Services (MMARS), we address those issues one patient at a time, each and every day. Through our years of case management experience, we have learned that our greatest impact on health, and in turn, financial outcomes, comes from taking a proactive approach to the health needs of our highest utilizing patients, and collaborating with their providers and payors.

We use an integrated approach to patient care that engages technology to identify high-risk, high-use individuals using clinical information like hospital admission data. Our nurses also collect information through comprehensive health-risk assessments, patient interviews, and clinical data to identify utilization patterns and risk factors for each patient.

The MMARS team then relies on evidence-based tools to build a care treatment plan that our case managers implement with our highest utilizers. Off-the-shelf case management is not the answer. Smart, proactive care management tailored to the specific needs of the patient can help provide the impact and change necessary to improve health outcomes and lower costs.

Carolyn Miller, RN
MMARS, Founder & President