Process Group
Care Management
Objective
Monitor and assess beneficiary’s care management progress to ensure appropriate and cost effective services are obtained and assess treatment plan to determine if modifications are needed
Input
List of beneficiary enrolled in care management programs
Diagnosis
Treatment plan
Pharmaceutical treatments
Output
Determination of whether beneficiary is obtaining appropriate care
Determination of whether beneficiary’s treatment is cost effective
Determination of whether a treatment plan modification is necessary
Measurable Outcomes
Appropriate treatment provided
Cost effective treatment provided
Chronic case costs