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

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf