Case Management

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Case Management Case management has become the standard method of managing health care delivery systems today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States; and it has been extended to a wide range of clients (Park & Huber, 2009). The primary goal of case management is to deliver quality care to patients in the most cost effective approach by managing human and material resources. The focus of this paper is on the concept of case management and how it developed historically, the definition of case management, the components of case management, and how it relates to other nursing care delivery models. History of Case Management The concept of Case management has was first introduced in the 1970’s by insurance companies as a way to monitor and control costly health insurance claims, commonly created by a catastrophic accident or illness (Jacob & Cherry, 2007). Today almost every major health care organization has a case management program managing and directing the use of health care services for their clients. Also, case management by payer organizations is recognized as external case management. Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ... ... middle of paper ... ...ut supplements nursing care in a health care facility (Jacob & Cherry, 2007). For example, if a hospital’s medical-surgical unit uses a team nursing approach to patient care, a system of case management also might be in place to assist with coordinating the patient’s total care through discharge (Jacob & Cherry, 2007). Moreover, case management is not always necessary with every patient in a health care facility. Typically case management is generally reserved for the seriously ill or injured, chronically ill, and high cost cases (Jacob & Cherry, 2007). In brief, case managers are a unique segment of the healthcare workforce. They share the same goals and standards of practice but are multidisciplinary and have diverse academic educational backgrounds and work environments (Park & Huber, 2009). case management leads to better manage health of individuals.

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