Why case management is important

Case managers understand the importance of achieving quality outcomes for their clients and commit to the appropriate use of resources and empowerment of clients in a manner that is supportive and objective. Case managers approach the provision of case-managed health and human services in a collaborative manner. Professionals from within or across healthcare organizations e. The healthcare organizations for which case managers work may also benefit from case management services.

They may realize lowered health claim costs if payor-based , shorter lengths of stay if acute care-based , or early return to work and reduced absenteeism if employer-based. All stakeholders benefit when clients reach their optimum level of wellness, self-care management, and functional capability.

These stakeholders include the clients themselves, their support systems, and the healthcare delivery systems, including the providers of care, the employers, and the various payor sources.

Case management helps clients achieve wellness and autonomy through advocacy, comprehensive assessment, planning, communication, health education and engagement, resource management, service facilitation, and use of evidence-based guidelines or standards.

They do so while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders. Case managers must demonstrate a sense of commitment and obligation to maintain current knowledge, skills, and competencies.

They also must disseminate their practice innovations and findings from research activities to the case management community for the benefit of advancing the field of case management. Caregiver The person responsible for caring for a client in the home setting and can be a family member, friend, volunteer, or an assigned healthcare professional.

Case management program Also referred to as case management department. Payor The person, agency, or organization that assumes responsibility for funding the health and human services and resources consumed by a client. Practice setting Also referred to as practice site, care setting, or work setting. Also refers to the professional background — such as nursing, medicine, social work, or rehabilitation — that case managers bring with them into the practice of case management.

Knowledge domain A collection of information topics associated with health and human services and related subjects. It refers to the presence or absence of illness, disability, injury, or limitation that requires special management and resolution, including the use of health and human services-type interventions or resources.

Health and human services continuum The range of care that matches the ongoing needs of clients as they are served over time by the Case Management Process and case managers. It includes the appropriate levels and types of care — health, medical, financial, legal, psychosocial, and behavioral — across one or more care settings.

The levels of care vary in complexity and intensity of healthcare services and resources, including individual providers, organizations, and agencies. Level of care may vary from least to most complex, least to most intense, or prevention and wellness to acute care and services.

Community services and resources Healthcare programs that offer specific services and resources in a community-based environment as opposed to an institutional setting i. These programs either are publicly or privately funded or are charitable in nature.

Benefit programs The sum of services offered by a health insurance plan, government agency, or employer to individuals based on some sort of an agreement between the parties e. Benefits The type of health and human services covered by a health insurance plan sometimes referred to as health insurance benefits, health benefits, or benefits plan and as agreed upon between an insurance company and an individual enrollee or participant.

The term also refers to the amount payable by an insurance company to a claimant or beneficiary under the claimant's specific coverage as stipulated in the health insurance plan. Client Source Before looking more closely at the phases of the Case Management Process, first consider what triggers the process. Acute care setting-based case manager May implement the Case Management Process for a client after referral from any of the healthcare team members, including the physician, primary nurse, social worker, consultant, specialist, therapist, dietitian, or manager.

Community care setting-based case manager May implement the Case Management Process for a client after referral from the primary care provider or specialty care provider. Collect necessary information through a review of current and past medical records, personal health records if available, and communication with your client's employer, health insurance plan representative, and others as you deem appropriate.

The Planning Phase The Case Management Process: Planning View larger image Click here to view map key for image The Planning phase establishes specific objectives, care goals short- and long-term , and actions treatments and services necessary to meet a client's needs as identified during the Screening and Assessing phases.

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