Care Transitions Today Podcast

Case Conversations: Strategies for Complicated Care & Payer Collaboration

This episode is co-presented by the Association of Physician Leadership in Care Management and the American Case Management Association. In this episode, we are joined by three physicians, Dr. Rebecca Severe, a Hospital Medicine-certified physician serving as Medical Director of Care Management for Advocate Aurora Health, Dr. Sweta Singh, Medical Director of Care Management at the University of Michigan Medical School, and Dr. Teresa Jacobs, Clinical Professor of Neurology at the University of Michigan Medical School.

In this episode, we delve into a multifaceted case involving a 76-year-old patient with a history of coronary artery disease, heart failure, and multiple comorbidities. The discussion highlights the intricacies of managing Medicare Advantage plans, justifying extended inpatient stays, and addressing payer resistance. Additionally, the episode shifts focus to the challenges of handling out-of-network denials, illustrated by a case of a 43-year-old female with a complex ankle injury and subsequent cardiac issues. The podcast shares insights on navigating out-of-network claims and ensuring appropriate care despite payer restrictions.