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Block 11; Week 2-M > Care Management of Medicaid/Medicare > Flashcards

Flashcards in Care Management of Medicaid/Medicare Deck (9)
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1
Q

How many people have chronic conditions?

A

1/4 of all Americans of 2+

3/4 elderly have multiple

2
Q

What is clinical effectiveness or efficacy?

A

Effectiveness–in the real world may not make a difference b/c of social factors etc.
Efficacy–ideal setting, research proven

3
Q

What are some social determinants of health?

A
poverty
low levels of literacy
limited English proficiency
minimal social support
poor living conditions
limited community resources
4
Q

What are some considerations in managing multi-morbidities?

A
patient preferences
guideline limitations
shared decisions
balanced actions
patient welfare
disease severity & consequences
parismonious care
5
Q

Who can be a care manager?

A
RN
social worker
pharmacist
behavioral health specialist
dietitian
nutritionist
non-clinical staff
6
Q

What is a comorbidity v. multimorbidity?

A

co–related to same central process

multi–unrelated, but often clump together for patients

7
Q

What are some key elements of case management?

A
healthy behavior promotion
health literacy
informed participant
collaboration w/ pt, family, providers
appropriate use of resources
8
Q

What is utilization management?

A

manage services & resources
ex: don’t prescribe antibiotics for viral illnesses!
track patients radiation exposure after tons of imaging.

9
Q

What are some things that a care management organization will provide?

A

enrolle services
provider services
administrative services