Introduction to Case Introduction to Case ManagementManagement

Introduction to Case Introduction to Case ManagementManagement

Why Case Management ?

The context of care is changing; we now have an ageing population and an increase in chronic illnesses that will demand more complex and costly care over a longer timeframe.

With the healthcare system facing increased pressure on acute hospital beds and finances, the importance of maintaining people in their own homes or community has become increasingly pertinent.

Chronic Diseases

A chronic disease is defined as a condition that requires ongoing medical care that can only control not cure, limits what one can do and is likely to last longer than one year

Impact of chronic disease

Origin of Case Management

The term case management originated in North America in the 1950s to describe the care given to community psychiatric patients.

At the start of the 1980s it developed into a strategy running alongside managed care to contain the costs of and focus the care of older people.

It came to the forefront in the 1990s when Medicaid, a healthcare scheme for older people, was revised to include the increasing provision of home and community care.

Case Management in UK

In the United Kingdom, case management is a term used to describe a range of strategies that improve the coordination of services for people with complex needs.

There is no one single model but a range of approaches that plan, coordinate, manage and review the care of an individual.

Case Management in UK

Case management involves working proactively with primary healthcare teams and patients to draw up personal plans for those who are identified as high-intensity service users or are at risk of hospital admissions.

The aim is to improve quality of life and coordinate care in the context of efficiency and cost effectiveness.

Case Management in UK

The UK government’s strategy for long-term conditions encompasses three approaches to care:

1. Case management is aimed at the limited group of patients (around 3% to 5% of the population) who have two or more longterm conditions with complex health and social care needs.

2. Disease management, the next step down, is aimed at patients with one long-term condition. Through the use of clinical pathways and protocols they are managed with support from a multidisciplinary team.

3. Self-management, the final layer, covers the majority of the population who are supported to take an active role in managing their own condition with support from healthcare professionals.

Definition

Case management is a system of health care delivery designed to facilitate achievement of expected patient outcomes within an appropriate length of stay. The goals of case management are the provision of quality health care along a continuum, decreased fragmentation of care across settings, enhancement of the client's quality of life, efficient utilization of patient care resources, and cost containment (ANA,1988).

Definition

Medical case management is defined as the process of assessing, planning, coordinating, monitoring, and evaluating the services required to respond to an individual's health care needs to attain the goals of quality and cost effective care.

Definition

The purpose of care coordination is to work directly with clients and families over time to assist them in arranging and managing the complex set of resources that the client requires to maintain health and independent functioning. Care coordination seeks to achieve the maximum cost effective use of scarce resources by helping clients get the health, social, and support services most appropriate for their needs at a given time. It guides the client and family through the maze of services, matches service needs with funding authorization, and coordinates with clinician and provider organizations (Williams & Torrens, 1993).

Goals of Case Management

1. Through early assessment, ensure that services are generated in a: time and cost-effective manner

2. Assist patients to achieve an optimal level of wellness and function by facilitating timely and appropriate health services

3. Assist patients to self-direct care appropriately, self-advocate, and make informed decisions to the degree possible

4. Maintain cost effectiveness in the provision of health services

Goals of Case Management

5. Appropriate expenditure of claims dollars and timely claim determinations

6. Enhance employee productivity, satisfaction, and retention, when applicable (CMSA, 1995)

7. Resolve medical issues8. Empower the patient to make informed

decisions9. Return the patient to work or assess the

patient's ability to return work and develop a plan that will assist the patient in returning work or becoming employable.

10. Enhancement of quality of care (Siefker et al, 1995)