Published
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.
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!
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....
renerian, BSN, RN
5,693 Posts
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