Therefore, the guerrilla approach to creating care management to is for the insurer to establish that nursing resource for themselves.
Based on what it's heard on the non-Medicaid 'street,' the DMCB assumes that would involve a retail cost of anywhere from $20 to $50 per enrolled patient per month. Assuming that's true, it would dedicate most of that cost to the nurses' salary and benefits but take a fraction and give it to the physicians in exchange for letting the nurses into the practice. The DMCB is no business person, but a back of the envelope calculation suggests that each nurses would have to carry from 150 to more than 200 patients to cover their salary and benefits. There's some additional cost including the use of a car and laptops. The DMCB thinks the nurses would need to be distributed geographically and serve a hub of primary care sites, starting with the clinics that serve a large proportion of the insurer's patients.
The DMCB suspects some physicians will simply refuse to let a nurse into their practice. Other physicians will demand to hire their own nurse in exchange for the option of collecting the entire fee of $20-$50 PMPM. Fine, says the DMCB, but it would want to see a care management job description connected to a live care manager and have the option of performing an audit of the care plans.