Case Management Case Study

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Evolving since the 1980’s, case management, an essential part of quality assurance programs, promotes excellence and efficiency in consumer health care, while conserving costs for health care organizations. Effective case managers answer the demands of changing health in promoting and facilitating a patient’s progression of care (Scott 2014). Historically, case management came to fruition as an answer to the shift of cost-based reimbursements to prospective payment models, assisting hospitals in keeping costs low regardless of the quality of care. However, as health care reform became effective, case management has grown into a newer role in assisting in the delivery of patient-centered quality care. Typically, case managers must be self …show more content…

Collaborative partnerships, among physicians and case managers, add value to the patient care by orchestrating care progression and coordination, supportive decision-making and cost-effective choices. The interaction of the case managers with multiple departments in a health system allows open communication, resulting in quality metrics demonstrating value in areas such as length of stay, observations, accounts receivable, and appeals or denials of patient care (Miodonski 2011). For instance, a patient presents with a myocardial infarction and a hospitalist orders an upper gastrointestinal series that is not necessary. The case manager in this particular situation seeks the necessity of the tests, preventing unnecessary testing and additional length of stay, ultimately improving the patient’s care and progression. Although hospital costs are avoided in this example, more importantly the case manager coordinated efficient movement and progression of care resulting in improved quality and accountability (Daniels & Frater 2011). There is no room for confusing managed care with case management, as managed care equals cost containment programs mandated by concrete systems. Case …show more content…

Typically, in current healthcare, case management assist in dissolving fragmented care for consumers, assisting in the progression of care. For example, in a hospital setting, patient care delivery provided by a combination of a surgeon, hospitalist, and a medical specialist allows for pathways of inefficient continuity of care. A case manager evaluates the entire treatment plan, managing complex care, and limiting the lack of continuity among providers (Daniels & Frater 2011). Collaboration with physicians’ decisions on clinical services and implementing accurate delivery of services by the facility exhibits strength of a case management program. However, limitations exist if physicians’ or administration do not allow the case management a respected position in decreasing healthcare fragmented delivery. Consistently, evaluation of medical goals, recommended clinical services, and patient treatment plans making sure they are in correlation with evidence based protocols and treatments, actually will improve healthcare quality, reducing length of stay and costs (Daniels and Frater 2011). Additionally, strengths of a typical case management program allow decrease in duplicate testing, improved discharge planning, and connections of ancillary departments. Case management programs assist in deleting

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