Process Group
Care Management
Objective
Reduce costs of managing catastrophic cases
Input
Diagnosis
Treatment plan (including all current therapies including pharmaceutical therapies)
Demographics
Geography (address for beneficiary)
Provider list
Rules
Output
Treatment needs assessment
Treatment plan or clinical pathway
Clinical recommendations to attending physicians
Care management
Case identifier
List of beneficiaries with catastrophic management needs
Provider list
Assignment of case worker
Assignment of restrictive benefits plan
Task Set
Identify cases whose liability will exceed cost threshold
Monitor these cases and assess treatment plans to see if there are ways to reduce costs
Communicate with clinicians at the hospital to suggest a cost-effective treatment plan
Measurable Outcomes
catastrophic case costs are reduced