Background: Outcome-based reimbursement models, along with increasing complexity of patient health issues, creates new incentives to improve care management, care coordination, and population health management in primary care settings.
Purpose/setting/sample: This quality improvement project examined the impact of integrating a BSN-prepared RN care manager at a regional federally qualified health center.
Implementation: Follow-up telephone calls, participation in interdisciplinary team meetings, and outreach to patients with Medicare advantage insurance plans (n=463).
Measures: Metrics were captured through primary and secondary data sources to quantify RN effort and revenue resulting from resolution of suspect conditions reports from the insurer as well as targeted UDS/HEDIS measures.
Results: RN care manager interventions, with estimated effort at a cost of $7,024.50 over a nine-month period, resulted in $61,040 of revenue generated through resolution of suspect conditions. Quality indicators also improved markedly, especially among colorectal screening and diabetic management indicators.
Conclusions: BSN-RNs working at their full scope of practice can be a cost-effective addition to the primary care team. They can provide a range of interventions to support positive patient outcomes along with revenue-generating services. Additional evidence is needed to continue to develop the value proposition of utilization of BSN-RNs in primary care practice settings and to promote nursing practice at full scope.
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8/14/20 1:01 pm
As an ASN RN with 30+ years of primary/internal medicine as well as emergency medicine knowledge currently holding a position as director of a care management department responsible for management of 30,000 Medicare/Medicare Advantage patients, I am not convinced by this article as to how a BSN RN versus a diploma or associate RN in the same role would significantly change your metrics.