Care management: A full immersion model

As the complexity of health care delivery systems evolves, and the variables to determine organizational success are modified, there is a need to change our care delivery paradigm to ensure success. The problem addressed in this study is the relationship between payment denials and length of stay (LOS) in the full immersion and traditional models of care management, an important issue as health care organizations struggle to improve health care and reduce costs. The purpose of this study was to gain a greater understanding of how the structure and definition of care management functions impact organizational success measure of LOS and reimbursement denials.;The researcher examined two different care management delivery models and the roles of the care coordinators. This research included adult patients on medical, surgical, and cardiac units receiving general, intermediate, and intensive care in a major hospital. The primary research question focused on what was the relationship between the full immersion and traditional models of care management on LOS and payment denials.;The results of this causal-comparative study demonstrated that the full immersion model of care management delivery had a statistically significant and positive impact on LOS and denials management across clinical specialty, units, and levels of care when compared to the traditional model of care management. The Medicare population did not have the longest LOS based on age. Additionally, LOS management was no more effective in managed care payers than in traditional plans; and the payer source did not have a statistically significant impact on LOS management or payment status.;New paradigms for the delivery of health care services will be necessary in organizations as leaders are confronted with conflicting pressures surrounding the need to reduce the cost of care while maintaining expected practices for high quality care. The positive social impact of this study is the demonstration that changes in care delivery models are possible and that changing our care delivery models can have a positive impact reducing healthcare costs.