The healthcare industry has changed tremendously over the years, but the one thing that has remained constant has been the ever-increasing cost of providing quality healthcare to patients. When you participate in RMM’s case management services, your employee will be assigned a dedicated Case Manager who will ensure the proper level of care is provided throughout the employee’s hospitalization.
RMM’s case management approach is broken down into 4 different categories.
The assessment phase focuses on the member’s injury or illness in order to identify the need for further case management services that are based on national, evidence-based guidelines. Key information gathered during the assessment phase of the employee includes, but not limited to, the current health condition and the past medical history. When an assessment is not completed on site or at a facility, the assigned case manager completes the review utilizing a telephonic case management approach.
The goal of our Utilization Management (UM) program is to oversee the medical care provided to the member and that the care is appropriate and meets medical necessity. The hospital notification process remains the key element in screening for medical treatment and diagnosis that may indicate a need for the implementation of case/disease management services, as well as to monitor the appropriateness of extended inpatient stays. Our expertise lies in the ability to identify appropriate options early in the disease process that assists with cost containment, without compromising quality care. RMM’s experienced case managers focus on eliminating inappropriate health care services to improve clinical and financial outcomes.
Care management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured members.
The care management phase is broken down into three stages.
The screening stage focuses on the review of medical records in order to identify the member’s needs and to develop a plan of care which coincides with the discharge plan. The case manager has two primary objectives during this stage, identify the member’s key problems to be addressed and develop a comprehensive case management plan of care that addresses these problems cost effectively. Based on the member’s overall condition, a second opinion may be required to prevent unnecessary procedures caused by medical errors or a misdiagnosis.
The planning stage establishes specific objectives, actions (treatments and services), and goals (short- and long-term) necessary to meet the member’s needs as identified during the screening stage. During the planning stage, the case manager develops a case management plan of care that considers inputs and approvals of the member’s healthcare needs. The plan is action-oriented, time-specific, and multidisciplinary in nature. It addresses the member’s self-care management needs across the continuum, especially services needed after a current episode of care.
The case management plan of care identifies outcomes that are measurable and achievable within a manageable time frame.
The following-up stage focuses on the review, evaluation, monitoring, and reassessment of a member’s health condition and needs, the ability for self-care, and outcomes of the implemented treatments and interventions. During this stage, the case manager generates daily outcome reports. The case manager’s primary objective is to evaluate the appropriateness of discharge.
The discharge planning phase centers around the safe transfer of the employee back to the country in which the employee resides if he/she is unable to return to work.
Repatriation Medical Management will assist in arranging a conference call(s) between the transferring physician and the admitting physician with a goal of providing continuity of care. We ensure that the employee is referred to the appropriate healthcare facility and that the admissions team is aware of the employee's medical condition.
Repatriation Medical Management will assist in locating a hospital that can provide the same level of care or the level of care that is appropriate at discharge.