About this episode
What if the people case-managing your care had a financial reason to keep you sicker? That's the uncomfortable question Scott Middleton puts on the table in this episode — recorded live from the American Case Managers Conference in Orlando, where Scott went to learn, and ended up being told Your Health didn't "fit" because they weren't a hospital.
Jamie and Scott unpack what the nurse case manager role actually looks like at Your Health — and why moving case management out of hospitals and into patients' homes isn't just better care, it's better economics. Scott shares the research proving the model works: 50% reduction in Medicare spend when patients are seen at the right frequency by the right people.
In this episode:
- Why hospitalists may be "the demise of the American healthcare system"
- The difference between nurse practitioners (diagnose and treat) and nurse case managers (assess and guide) — and why blurring them costs patients
- The 16.05-visits-per-risk-point model David Clemens' research validated
- How coding departments are quietly diagnosing patients with diseases they don't have
- Why Medicare's 6-year insolvency window may be the disruption we need
- Head-to-toe assessments, delegation rights, and the real job of an RN in the home
If you've ever suspected the system is working exactly as designed — just not for the patient — press play.
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