Why Case Management?
There has been growing buzz around case management services in the United States recently. While a large number of people need case management every year, many people are not aware of what case management means. In this article, we shall clear the air surrounding case management.
What We Do?
The concept of case management means different things for different people and organizations. According to the Case Management Society of America, “Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.”
What makes us different
Does that sound too complicated? Let us explain. Case managers basically have several functions that they perform which basically include education, care coordination, compliance, transition management and utilization management.
Case management service providers are tasked with providing education relevant to the effective progression of care, the appropriate level of care and safe patient transition. They provide the necessary information to the health care team and the patient/family/caregiver regarding available resources for various medical services that the patient needs. They also provide information to the patient to resolve any issues detected with their medical care in their assessment.
Case management service providers have a defined process in place for screening/identification and assessment of patients. Case managers screen the patients to identify clinical, psychosocial, financial and operational factors that can have an effect on the progression of care. They then review and ensure the plan is clinically appropriate, matches the patient’s care needs and is consistent with patient choice and available resources. Lastly, they communicate their assessment findings with the patient or their family.
The case managers will develop and coordinate a transition plan, which is based on their assessment of the patient, choices of the patient and the available resources. Case managers will intervene to prevent readmissions and evaluate patients who are readmitted to identify and implement strategies for improvement. Not only that, the case manager will assess the available community resources/potential partners and advocate for resolution of gaps in the available resources and processes.
Case managers possess the requisite knowledge and expertise of compliance with the federal, state, local hospital and accreditation requirements. Thus, they ensure compliance regarding their scope of services.
The case manager will ensure that the patient is receiving the appropriate level of care by way of secondary physician review. They are expected to ensure timely communication to the payer of the patient’s bills to support admission, medical condition and authorization for continued stay.
Other Services We Provide
Our case managers sift through the array of resources, select the most appropriate path, and then we coordinate the expertise and support of other professionals, family, employers and other providers to facilitate the services medically required for your health needs.
We use a combination of perception, planning, active-listening, empathy and compassion to utilize resources to prevent roadblocks that may hinder you from receiving care.
Our case managers come from a diverse educational and clinical background in nursing or other related health field in order to provide our clients the knowledge and understanding of their care in order to prevent health complications.
Case Managers believe that close communication with the physicians and other health care providers is key to a successful plan of care.
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Frequently Asked Questions
Why is case management important?
The primary function of case managers is to advocate for clients/support systems. 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.
What is case management in public health?
The definition of Case Management is. “to promote health education, prevention, control and/or minimization of disease and disability; through assessment, examination, diagnosis, evaluation, and care planning activities in a community.
What does a medical case manager do?
Medical case mangers serve as liaisons between medical doctors and their staff, as well as patients who have long-term health problems. They are primarily responsible for monitoring patients' treatment and insurance coverage plans to ensure that their needs are entirely met.
What is the role of case management in healthcare?
Case management is a process by which a patient's condition is assessed and options are discussed with the appropriate doctors and nurses to ensure the most timely, safe, and cost-effective care. A case manager enables not only patient satisfaction, but also reductions in patient length of stay and healthcare costs.
What are the roles of a case manager?
Accomplishes clients' care by assessing treatment needs; developing, monitoring, and evaluating treatment plans and progress; facilitating interdisciplinary approaches; monitoring staff performance.
Admits new clients by reviewing records and applications; conducting orientations.
What is healthcare case management?
Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality of care