disease mgt vs. case mgt

BBFRN, BSN, PhD · Apr 8, 2008

Hi rxrn;

I'm a telephonic disease mgr, who works alongside CMs, UMs, and UR nurses.

My patients consist of employees of a large national corporation, and their covered family members. They have to have at least 1 of the dx's we cover for our DM program. These are conditions that are considered as high cost, and have been proven to improve with education. I educate patients over the phone re: type 2 diabetes, HTN, hyperlipidemia, low back pain, asthma, and ischemic heart disease. I teach them about their disease process, about their meds, what their test results mean, and ways to improve their health status. We do this by verbal teaching over the phone, and by sending them ed materials.

If someone has a lot of other comorbidities, or if they're incurring a really high level of cost in their medical care, then I will refer to a CM. I don't have to authorize care for anything but diabetes education. I have no idea why our DMs do that, but that's how the employer wanted it. It does work out well that way, because I will engage them in my DSM program to back up what they've learned in diabetes ed.

I had 12 years of bedside nursing behind me when I started, but I have worked with some DMs that only have 2 years experience, and they do just fine. The hardest part for me starting out, was doing an "assessment" over the phone. This rests largely on the primary medical history, and this patient population is able to provide self-care, so it's not hard after you get over not being able to visualize the pt. Another hurdle to overcome was in learning about primarily chronic disease processes vs. acute. I worked in critical care, and the ER, so there was definitely some learning for me to do.

Another thing I had to understand, is that outcomes are measured by cost savings by the employer, instead of my nursing outcomes (i.e. the pt now has a manageable A1c, for example). I do record those outcomes, but the employer looks more at money saved.

I work 5 days a week (office hours), and have weekends/holidays off. I will be working from home by the end of the month (Whoot!).

rxrn · Apr 9, 2008

thank you so much for taking the time to answer my queries. i guess everybody has been so busy these days...i appreciate your effort.

i was looking into disease mgt. i know its very much different from bedside nursing. so how does your day go?

ned

BBFRN, BSN, PhD · Apr 10, 2008

It's basically spent at a desk on the phone all day, either making enrollment calls, taking medical histories, giving recommendations, or following up on patients to see how they're doing. Nothing stressful or dramatic, and my patient population is a really nice group to work with. It's very low-key.

rxrn · Apr 11, 2008

It's basically spent at a desk on the phone all day, either making enrollment calls, taking medical histories, giving recommendations, or following up on patients to see how they're doing. Nothing stressful or dramatic, and my patient population is a really nice group to work with. It's very low-key.

how many cases do you handle?

do you have a recommended website that i could go to to learn more about it?

thanks again.

BBFRN, BSN, PhD · Apr 11, 2008

rxrn,

I sent you a PM. :)

rntrap · Jun 19, 2008

I have a phone interview for Mckesson for Disease Management. Any tips for the interview?

BBFRN, BSN, PhD · Jun 21, 2008

See the thread you started today regarding your interview for my response.

Good luck to you!