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Managed care contracts. A guide for clinical case managers

C A Rehberg1

  • 1Superior Consultant Company, Inc., Farmington Hills, MI 48334, USA.

Nursing Case Management : Managing the Process of Patient Care
|March 1, 1996
PubMed
Summary
This summary is machine-generated.

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Effective managed care requires integrating clinical expertise, not just discounted services. Nurse case managers are vital for successful contract development and managing patient care within these systems.

Area of Science:

  • Healthcare Management
  • Clinical Operations
  • Health Policy

Background:

  • Managed care is often implemented without the crucial
  • management
  • component, leading to "discounted care" rather than effective management.

Purpose of the Study:

  • To present an overview of the managed care contract development process.
  • To provide tools for nurse case managers to actively participate in contract development.

Main Methods:

  • Review of managed care principles and contract development.
  • Emphasis on the role of nurse case managers in bridging clinical and financial aspects.

Main Results:

  • Successful managed care organizations integrate management, finance, and clinical resources.

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  • Nurse case managers are essential for managing contracted populations and ensuring optimal patient care.

    • Conclusions:

    • Nurse case managers must understand managed care concepts and terminology.
    • Active participation of nurse case managers in contract evaluation and review is critical for success.