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Question: Implementing a Managed Care System
You are the director of a home health agency that has recently become part of a managed care system. In the past, only a physician's order was necessary for authorization from the Medicare system, but now approval must come from the managed care organization (MCO). In the past, public health certified nurses (all BSNs) have acted as case managers for their assigned caseload. Now the MCO case manager has taken over this role, creating much conflict among the staff. In addition, there is pressure from your board to cut costs by using more nonprofessionals who are less skilled for some of the home care. You realize that unless you do so, your agency will not survive. You have visited other home health agencies and researched your options carefully. You have decided that you must use some type of team approach.
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