Implementation of a managed care model in an acute care setting

Area of Science:

• Nursing
• Healthcare Management
• Quality Improvement

Background:

• Recent nursing literature focuses on the evolution of outcome-based care models.
• Patient-focused care, case management, and managed care are key approaches to redesigning patient care.
• The core goal of these models is to deliver quality care efficiently using appropriate resources.

Purpose of the Study:

• To describe a managed care model implemented at St. Margaret Mercy Healthcare Centers.
• To highlight the role of the staff nurse in coordinating patient care within this model.
• To define managed care as a unit-based approach focused on specific patient outcomes.

Main Methods:

• Implementation of a managed care model at St. Margaret Mercy Healthcare Centers.
• Focus on empowering staff nurses as central members of the multidisciplinary team.
• Development of care pathways initiated at the staff nurse level.

Main Results:

• The program positioned the staff nurse as the primary coordinator of patient care.
• This model, initiated at the staff level, is defined as managed care.
• Managed care aims to achieve specific patient outcomes within defined lengths of stay.

Conclusions:

• Managed care, with staff nurses coordinating care, is an effective model for outcome-based care.
• This approach ensures quality care delivery in a timely and resource-efficient manner.
• The model aligns with the principles of fiscally responsible and patient-centered healthcare.