Nurse Care Manager/Care Coordinator Best Practice Sharing Committee: Care Management Effectiveness

  • 03 Feb 2020

Blue Cross and Blue Shield of Rhode Island (BCBSRI) delegates care management functions and responsibilities to PCMH-recognized practices.  Stephanie Gill, BCBSRI Business Planning Analyst, and Kate Reilly, RN, MSN, Quality Concierge Team, have consulted with 177 NCQA-recognized PCMH primary care practices to discuss current care management processes and cost and quality outcomes. BCBSRI provided an overview of their findings looking at areas such as policies, identification of patients needing care management, care management assessments, interventions, follow-up and discharge. Follow-up meetings were requested so that there could be more discussion regarding NCQA guidance on care management delegation and how NCM could learn more about patient benefit information.

Forty-two (42) nurse care managers/care coordinators have recently registered to attend the GLearn Core Curriculum Training Program (funded by UnitedHealthcare) which provides training on identification of high-risk patients, assessment and intervention. Each NCM/CC has been assigned to a NCM Faculty and cohort; training will start in the next two weeks.