Mary Ellen Gervais, PhD, RN, CCM, vice president of InforMed Medical Management Services, is involved in the ongoing development of an integrated case management software system that targets and helps manage the 10 percent of patients that account for the majority of healthcare spending in the U.S.
This software, one of InforMed's
main products, guides case managers and nurse navigators in evidence-based case management to measure health outcomes.
Gervais, a registered nurse with more than 20 years of case management experience, is a faculty member on the upcoming Dorland Health/URAC webinar, Boosting Outcomes in the Medical Home Through Case Management, on Jan. 26 at 2 p.m.
To get a deeper understanding of the software she helped develop, Medical Home Today sits down with Gervais, who also discusses the role of the case manager in the medical home model.
Medical Home Today
: Can you describe your integrated case management software system?
How does it work in relation to the medical home model?
Mary Ellen Gervais
: Our software is the InforMed Data Warehouse and Medical Management Outcomes Tracking System (MMOTS).
: Our experience with working with physicians and assisting in the development of medical homes has shown that there are two primary obstacles to physician engagement in these initiatives.
: With attention to the high and moderate risk participants, health plans have usually seen a financial impact shortly after the patient-centered medical home initiative has been started.
As the personal health nurse continues to address the high and moderate risk needs, cost savings continue.
As the personal health nurse and the provider work together to address gaps in care for the provider population, longer term impact on cost occurs as improvement in adherence impacts clinical status.
: Explain how a case manager in a medical home can improve transitions of care.
: As the nurse is working to support the treatment plan, coordination of necessary services becomes key.
Gervais: The personal health nurse is aware of the holistic needs of the participant.