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Disease Management how many are there ?

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by renerian renerian, BSN, RN (Member) Member

renerian is a BSN, RN and specializes in MS Home Health.

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I have posted this question before but it has been a long time so I want to post again to see if there are more nurses in DM.

I wanted to know because I would like to approach allnurses about adding a

DM thread.

Thanks,

renerian

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renerian is a BSN, RN and specializes in MS Home Health.

5,693 Posts; 15,237 Profile Views

Wow, none so far.

renerian

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dria has 10 years experience and specializes in home health, peds, case management.

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sorry renerian....i am a traditional cm....try to get all my members into your dm programs....would be interested in participating however as i have a number of members who either dont have a dm program or decline to participate.

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Many of the large insurance companies have disease management now. Even medicaid/medicare is starting to have disease management programs.

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renerian is a BSN, RN and specializes in MS Home Health.

5,693 Posts; 15,237 Profile Views

Thanks for the reply on DM. I was hoping to see someone reply. I know alot of companies have their own DM programs. I was wondering if it would be worth having our own thread but it does not appear to have enough people that are interested.

renerian

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dria has 10 years experience and specializes in home health, peds, case management.

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many of the large insurance companies have disease management now. even medicaid/medicare is starting to have disease management programs.

i work for one of the "large insurance companies."

however, i work on the self-insured (aso) side, so it is completely up to the employer group as to whether they opt-in to the disease management programs....not all do.

so, if i am case managing a member who works for an employer that did not purchase disease management, and his diabetes is poorly controlled, do i tell him "oh thats too bad, your employer didn't purchase anything to help you" or do i spend the time getting him back under control?

i believe in dm and think its great, and would prefer that you "experts" handle these difficult cases. however, it is not always an option, and i would take any opportunity i can to learn from you to better serve my members.

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I have seen people post about DM here and on the telephone triage section. There are actually more of us :) DM is a large part of my job however I have other responsibilities also. We also have some ASO groups that do buy our DM program.

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Dri...

What type of DM do you need help in? Does your company do DM for fully insured and if so there will be tools and information to help you with your ASO customers.

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dria has 10 years experience and specializes in home health, peds, case management.

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wincha,

very sweet of you to offer. yes, we do dm for both the aso and fis. however, it's been a challenge locating the dm resources...our resources are split into cm and dm areas. being classified as a cm, those resouces are a challenge to find. however, being creative (and nosy) in finding resources, i've been able to get what i need. anything that i find helpful is fair game. it's not a matter of needing help in any specific area, i would just like to stay on top of my game...i'm sure you understand if your program is set up so that you manage comorbids as well as the dm diagnosis.

if i ever do have a specific question, i am confident that you dms will help me...you've been warned!

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renerian is a BSN, RN and specializes in MS Home Health.

5,693 Posts; 15,237 Profile Views

I am hearing winds that in the future DM and CM will merge, which makes sense. Is anyone else hearing that in their networking groups. I am considering joinging a CM local group.

renerian

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dria has 10 years experience and specializes in home health, peds, case management.

246 Posts; 5,445 Profile Views

i think a lot of merging cm and dm depends on they type of dm company you work for...

like i mentioned before, my company is set up so that our "in-house" dm nurses manage the referred condition and the comorbids...essentially, they take on that pts case management needs. however, if the dm is managed by an external vendor, that external dm company only handles the referred condition, and we continue cm for that pt....

i think that merging cm and dm makes sense....more continuity for the pt...and that does seem to be the way things are going...

i say go ahead and join that cm group...i think that you will bring a unique perspective to the group, and you may find some ways to improve your own practice....

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