Case Study: Outpatient Provider

Case Managers have a challenging job, often dealing with patients, community agencies and facilitating their hospital discharge to the next level of care. They collaborate and communicate with the entire healthcare team and mostly with the patient during the hospitalization process. They act as support for all stakeholders to achieve positive patient outcomes. In this paper, I will be interviewing Ian Mopas, who is a Patient Care Coordinator at Kaiser Permanente in Redwood City about his education, work training, goals, and objectives as a Care Coordinator, and his responsibilities in his organization.

Thank you for giving me your insight on working in an outpatient facility. I really appreciate getting other's opinions about careers in the different available medical areas. I'm unsure right now which area that I'm more interested in working, but the outpatient facility and payer facility areas both seem intriguing to me. I like the idea that you stated of getting to know the patients on a more personable level and seeing them improving daily in their condition. It sounds very interesting and rewarding.

Jones Regional Medical Center is a huge academic health center with 900 beds and are known for its research and teaching hospitals. Additionally, the IT staff at Jones supports 300 applications and 12,000 workstations. The center uses Technology Med (TechMed) for their admitting system. The system includes registration, inpatient charge, payment entry, master patient index, admission, hospital billing, and more. The TechMed system has been accessible since 1998; Jones is beginning to plan a replacement of this systems because of the fragility of the software (Wager, 2013).

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

In the case of Jared, he is seeking treatment after being in an inpatient alcohol treatment center. In patient services helped him focus on addressing his addiction to alcohol and what triggers him to drink. Jared can benefit by using outpatient services. Outpatient services will help Jared by giving him more freedom to allow his commitment to family responsibilities at the same time attend his sessions (Erford, 2013). Jared must abstain from alcohol which requires a lot of willpower but outpatient can offer him support groups, individual counseling, and family counseling, so Jared will never feel like he is alone in his recovery.

Wisconsin has a number of serious drug threats affecting state residents. Illegal drugs such as crack and meth are readily available in many areas of Wisconsin, and responsible for a number of drug rehab enrollments. Wisconsin drug rehab programs in the eastern region have experienced an influx of methamphetamine-related admissions. However, cocaine addiction enrollments are reported to be a statewide problem. Additionally, the illegal use of prescription drugs has sent a number of residents into the E.R. as well as Wisconsin drug rehab treatment. Also, younger residents struggle with underage drinking.

Kaiser Permanente Colorado is proud to offer a program that allows safety net primary care providers to electronically request advice from select Kaiser Permanente specialists. Currently eight speciality departments participate in this program that supports safety net primary care providers, the patients are uninsured and below the federal poverty level.

The Centers for Medicare and Medicaid Services is the government body in charge of managing Medicare and Medicaid programs. CMS likewise runs the State Children's Health Insurance Program (SCHIP), which is mutually financed by the Federal and State governments and managed by individual States. ACA created major change in CMS's implementation responsibilities.

The metropolitan classification program is used to determine home mortgage loans, loyalty pay program and varying policies within the Medicare program. The geographic established boundaries of a metropolitan area are representative of that area’s marketplace. Property data collected from the area is reported to bank regulators who will use the data to evaluate lending performance. The data collected could potentially cause bank regulators to consider altering lending practices to suit the area.

Objective A: After 5/2/17, the consumer has missed two appointments with outpatient therapy. The consumer has stated that he wanted to hang out with his friends at the barber shop in lieu of going to his outpatient appointment with the MHSS. The MHSS has discussed the importance of outpatient therapy with the consumer and the consumer acknowledges that he needs outpatient therapy but he refuses to go or makes excuses not to go. Objective B: The consumer and the MHSS reviewed the consumer’s appointments with outpatient therapy and a PCP check up. The consumer was able to review the paper work for the PCP (Dr. Chinnery of Divine Health Group) however he declined help from the MHSS in reviewing the intake packet. The consumer stated that

The consumer will be discharge once he has been link to New Center Community Mental Health and meet with is treatment team. The consumer will stay in compliance by attending all his appointment at New Center and address any concern regarding any medication to his doctor and therapist. The consumer will also discuss his current situation with his treatment team so that they can help provide him with the resources he need regarding housing and

Stephanie is a personable candidate with a solid background in medical billing. She has extensive experience working in billing, as well as both insurance and patient follow up. She has worked with Medicare, Medicaid, and commercial insurance. Most of her applicable experience comes from her time with Coram Healthcare. She left this position when they relocated out of state. She is currently working in a contract role outside of the medical billing industry. It is set to complete in the next week or two and she would prefer to return to a stable environment in the area of medical billing.

Miami County is home to Grissom Air Reserve Base. Grissom is one of only five Air Force Reserve Command bases in the nation, essentially housing Air Force personnel, but also organizations from other branches of America’s armed forces including the Army Reserve and the Marine Corps Reserve. Active duty personnel numbers such as these combined with the county’s populace of veterans generates a greater demand for health care services from the Veteran’s Health Administration (VA). If I were given the chance to identify and improve a problem in my community, I would expand the VA Community Based Outpatient Clinic.

The first step in her treatment is to get her to process the migration change and the loss of her friend. I would do this is by doing intense case management doing home and school visits to check in with Kay. The next step would be getting her to disclose if she is doing drugs, and if she is which is likely I would place her in a residential treatment center. If the family resist I would explain to her the benefits of she being placed in a residential versus out patient, and the best part is that none their family members would know, they can tell them she is going to boarding school.

Chapter 7 talks about outpatient services and primary care. When someone is a outpatient they do not stay overnight at a hospital. The care they receive does not require hospital stay. There are many outpatient services you can receive. A few examples would be primary care and dental care. Primary care is very important to our healthcare system, primary care is different from secondary care, because of the duration and intensity of care. Secondary care tends to be more short term. Primary care focuses on prevention, diagnostic, therapeutic and health education. Point of Entry is what the book describes as the entry point in which health care is delivered. Coordination of care was also discussed, this is when the physician advises the patient on what path to take