Source: HealthLeaders Media article on new Pricewaterhouse Coopers Health Research Institute Report

“While most hospitals have focused on promoting quality care at their facilities to help decrease costs, quality care will take on a somewhat different meaning under the new healthcare reform law: Hospitals will feel the pressure to maintain continuous quality improvement or risk being penalized under reform incentives scheduled over the next several years, according to a PricewaterhouseCoopers’ Health Research Institute report titled Health Reform: Prospering in a Post-Reform World.”

Read the article from HealthLeaders Media: How Quality Will Pay for Hospitals Under New Reform Measures

Read the Full Report from Pricewaterhouse Coopers at: Prospering in a Post-Health Reform World

J.D. Power and Associates just released their latest review of health plan member satisfaction.  According to the study, member satisfaction has declined since 2009. 

“The study examines seven key factors: coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes.” Here are some key findings in the report:

-          Member satisfaction fell in 2009 and dipped below 2008 levels

-          Most notable contributor to decline in member satisfaction was an inability to understand plan coverage and benefits

-          Only 10% of health plan members understand the latest healthcare reforms

-          Members who were able to choose their carrier had the highest levels of satisfaction and were seven times more likely to remain with their carrier in the future

For more information about the study click on the J.D. Power and Associates 2010 U.S. Member Health Insurance Plan Study^SM

It should be an exciting time for case managers. Healthcare reform is in it’s creation and The RAC (is it not the perfect nom de guerre?) is knocking on our doors. Yet I hear nothing from our ranks or leadership weighing in on the issues.President Obama recently made notice of an article in the New Yorker by Dr. Atul Gawande. This article was about a Texas city that had the highest cost per Medicare patient in the US. It’s conclusions said nothing that any nurse case manager could not have told him about over utilization. The reform issue of “how are we going to make universal healthcare affordable?” is all about case management principles. If the future of healthcare delivery is going to be based on the principles of the right care and the right time, it is going to take case managers to make it work. Focusing on the here and now, The RAC is the best thing ever to happen to hospital based case management. Hospitals will not be able to survive without strong UR/ case management programs.
Ray Gridey, RN BS, CPUR – Case Manager