Spreadsheet: 17259f6d-542b-4812-8f78-35f2c308185b
Sheet: Carrollton

Date | Dep | Trigger 1 | Stop Loss question | [NAME] response
2013-10-11 00:00:00 | 3 | Congenital CAHS, Esophageal Candidiasis, Biliary Tract Disorder | What is the current clinical and status of this claimant to include prognosis and estimated treatment cost for the next 12 months? | 10/11/13 SL Update:  7 y/o child with new diagnosis of neuroblastoma with metastasis. Child has multiple medical problems: [NAME]'s syndrome, vent dependent from birth, [NAME]'s and congenital central hypoventilation syndrome.  [NAME] was admitted to hospital for chemotherapy, clinical trial (not approved by City and TML IEBP). After discharge he was re-admitted 3 days for severe reaction to initial chemotherapy given during hospitalization. Parents plan on improving childs nutrition and focusing on quality of life. MD informed family “he is in agreement w/this plan for now, with them understanding that child will die from his neuroblastoma w/o further therapy”. PROGNOSIS POOR.
2013-10-11 00:00:00 | 2 | Mitral [NAME], Mucopolysaccharidosis, Aortic Valve Disorder | What is the current clinical and status of this claimant to include prognosis and estimated treatment cost for the next 12 months? | 10/11/13 Update: The member's TML IEBP coverage effective 2/1/12; he is the dependent son of the enrollee. [NAME] is a 24 year-old male with a confirmed diagnosis of MPSI (Mucopolysaccharidosis), in the form of a particular variation called Hurler-Schele phenotype, which is an inherited genetic disorder that is life threatening without the medication, [NAME]. The member receives weekly infusions of the IV medication, along with IV fluids for hydration prior to the administration of the drug, [NAME]. This cost of this treatment has been approximately $200,000/annually - that is drug cost alone. The insured was known to have some cognitive decline over the last couple of years, but had not required inpatient hospital intervention as of the last stop loss update. The member is known to be in a clinical trial at UTSW related to Intrathecal Aldurazyme administration; the health plan was not funding this. Multiple attempts have been made by Care Management to engage the member, but without success. dh Prognosis: Guarded
2013-10-11 00:00:00 | e | Pertoneum CA NOS, [NAME], Other Ascites | What is the current clinical and status of this claimant to include prognosis and estimated treatment cost for the next 12 months? | 10/16/13 Update: Pt is 49yo F PMH:  malignant peritoneal mesothelioma, umbilical hernia, ascites who is s/p electrodissection electrosurgery, laser ablation, laser resection and cryosurgery.  Procedure was HIPEC that is inclusive of heated intraperitoneal chemo.  SR advisement was  to approve surgery for this dx.  Admit IP 12/13/12 for pain control, prep and [NAME] pre-surgical nutrition and surgery performed 12/27/13.  Pt dx after w/u for ascites.  Pt seeing Oncology at MDACC.  12/12: extensive lap, peritonectomy, partial colectomy and omentectomy.  Pt received single dose intraperitoneal platinum and then referred back to MDACC for x4 cycles chemo with Alimta and carboplatin (every 3 week cycles) and did well. F/U MDACC 7/13: CT’s were read as essentially normal, no abnormalities in chest and abd, minimal perisplenic ascites but no masses.  Pt then started  chemo with Alimta as single agent chemo 8/2/13 to complete 4 cycles.  Pt f/u 9/13 finds imaging improved and pt feeling better, Onc f/u q4 months. CPRN for KMillerRN PROGNOSIS: Guarded
2013-10-11 00:00:00 | t | Malignant carcinoid tumor, acute respiratory failure, hemorrhage comp | What is the current clinical and status of this claimant to include prognosis and estimated treatment cost for the next 12 months? | 10/16/13 SL Update: Pt is 36yo F PMH: polycythemia vera, hypothyroid, anxiety/depression, HTN, SOB, hypercoagulopathy with very large spleen s/p lap appy.  Pt had miscarriage during 5th month pregnancy & developed appendicitis and req lap intervention.  Appy path: 0.9 cm goblet cell variety adenocarcinoid mass and because of the adenocarcinoit nature of goblet cell variety, R hemicolectomy recommended to harvest her lynph nodes on 5/20/13.  Postop pt had signif. bleeding from rectum, colonoscopy demonstrated oozing from anastomosis (not appear to be surgical and anastomosis as clipped and injected w/epi.  Pt then to ICU unstable condition.  Req. 4 u PRBC and seen by Dr [NAME] (adv. PLT NL) an to transfuse 2nd PLT count normal may not be functioning as should so got 1 unit platelets+DDAVP.  CT abd+pelvis: fluid in abd, no obv leaks.  2 days later tharnsfer to IP Acute but ^ [NAME], CT then reveal small leak and signif tender so back to OR.  Pt had old blood RUQ and pelvis and drainage of hematoma around anastamosis.  Pt had 2nd takedown of anastomosis and given an end ileostomy and mucous fistula (done 5th day postop).  Back to ICU, improved, tol low residue diet w/good ileostomy function, hematologically stable.  mesenteric nodes neg.  POC: close colostomy 3-4 months and pt to f/u with Oncology to monitor condition and admin. DDAVP or platelet transfusion if need preop.  CM to open to Case Management, Med. Oncology advising no active chemo needs at present.  7/13 f/u with Surgeon: well healed, appetite not as good, looking forward to ileostomy closure. Pt changes ileostomy bag ~10x/d. Pt also dx during postop recovery with cavernous sinus thrombosis (on [NAME]) so MD plans [NAME] bridge to surgery (no DDAVP or PLT needed).  Pt admit MC Plano 9/16/13: colectomy (partial w/anastomosis, closure of enterostomy stoma & had DDAVP + Platelet transfusion postop.CPRN PROGNOSIS: Guarded
2013-10-11 00:00:00 | s | chest pain, [NAME], nausea alone, esophageal candidiasis | What is the current clinical and status of this claimant to include prognosis and estimated treatment cost for the next 12 months? | 10/11/13 SL Update:  51 y/o female with history of hypertension, diet controlled DM, gall bladder disease, carpal tunnel syndrome, corneal ulcer, intractable migraine headaches, chronic pain syndrome, depressive disorder, GERD, hx of breast cancer with reconstruction, ^ cholesterol, lumbago, morbid obesity, obstructive sleep apnea, neck pain, cardiac dysrhythmias. Neurologist reports the member is currently disabled and has a past history of narcotic addiction. He has recommended an external nerve stimulator. Member has multiple medical problems which have resulted in 23 trips to the ER since 10/14/12 and 13 ambulance services from 10/16/12. Evaluating medical services, procedures and diagnoses billed to date I do not foresee a change in member’s utilization of the health care system or the Health Benefit Plan. Prognosis: Fair.
2013-10-11 00:00:00 | s | [NAME] leg, DM2 | What is the current clinical and status of this claimant to include prognosis and estimated treatment cost for the next 12 months? | 10/16/13 Update: Pt is 54yo F PMH: depression, anxiety, HTN, CLD, CKD, DM2, ^ lipids, obesity, OA, lumbago, RLS.  Pt admit IP 1/29/13 for R TKR at Forest Park MC x3 day LOS, and readmit 4/9/13 for L TKR at Forest Park MC x3 day LOS.  All rehab in OP PT setting.  Pt had same sxs and findings both knees: sxs of sharp pain, soreness, buckeling of joint, decreased ROM, s/p series Supartz injection but still ^ pain medially and patello-femoral joint now laterally.  Pt orig wt at 325, pt had intentional wt loss 1/13 to 260, by 4/13 was back to 280#.  Pt had OP PT at ortho office as rehab between 2/13-6/13.  A1C 7 (7/13), BS 80 (7/13), [NAME], GFR 63.  Pt now stable but with significant comorbid conditions (DM2, CKD, ^lipids, obesity) that will likely have impact on cost of care in next 12 months. Prognosis: Fair