Practice Guidelines, Managed Care, and Utilization Review

"While you were Wheezing"

      Childhood asthma is one of the most common conditions targeted by managed care organizations for patient education.  Patient education,  which is used to help keep children well and out of hospitals and emergency rooms, is usually a valued component and a covered service for most managed care plans.  Not only is it good for the patient and family, it usually results in substantial cost savings.  The PCP should, however, assume ongoing care of the patient after completion of the education.  It is very important that the PCP becomes familiar with the details regarding the education program. 

     For Janie, it will be necessary to determine if her health plans covers patient education. It very likely does.

     Another valuable component of health care for chronic conditions might be case management. 
 

Does Janie need case management services?                   Yes                 No

Is she eligible for case management?                                    Yes                 No
 

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