Kay Sackett

Demonstrating a positive return on investment for a prenatal program at a managed care organization. An economic analysis.

Healthcare providers need information to guide the management of patient health while administrators focus on resource management. The underpinning of economic analysis, in the clinical setting, is that resources are scarce. The allocation of resources requires delivered services to provide more benefits than cost and hence, the need to demonstrate a return on investment (ROI) for disease management programs. This article describes the ROI for a prenatal program developed at a Western New York Managed Care Organization (MCO). A positive ROI for the program under study will be demonstrated using a model of economic analysis.

Guidelines for evaluating tools for clinical decision making.

Managed care is designed to reduce healthcare costs by controlling use of services and by improving quality outcomes. Preparation of nurses to practice in a health management environment mandates clear understanding of this new environment. Nursing educators should focus on the spectrum of health services and enhance the nurses’ ability to assess patients independently, implement health plans, and be responsible for outcomes. Nurses must understand how clinical decision-making tools facilitate planning care to maximize use of resources. The authors describe the construction and evaluation of a learning strategy that involves the use of guidelines to evaluate clinical decision-making tools. Two examples are presented: evaluating clinical pathways in a case management project and evaluating algorithm (practice guideline) outcome data from a prenatal population case study from a local health maintenance organization.