Case Management in Healthcare: History, Definition, and Components

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 &ump; 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 The concept of Case management has was flirts introduced in the ass'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 ass's to manage the lengths of stay of hospitalized patients and the treatment plans Jacob &ump; Cherry, 2007).

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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 (DRAG), 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 had to efficiently manage the treatment provided to a client and reduce the client's length of stay Jacob &ump; Cherry, 2007).

Case management, or internal case management "within he walls" of the health care facilities was created to streamline costs while maintaining quality care (Jacob &ump; Cherry, 2007). Hospitals felt the pinch of payment shortfalls In the early to mid-asses resulting from the prospective payment program (Daniels &ump; Prater, 2011 Because of this dramatic change In organizational culture which engaged hospital employees and physicians in cost savings and delivery of care efficiencies, hospital governing bodies explored the consulting world to help rein in costs and reduce the length of stay of patients (Daniels &ump; Prater, 2011).

During this time many hospitals many hospitals agonized a new financial reality and had to downsize, reduce staff, or simply close (Daniels &ump; Prater, 2011). Hospital case management programs then began to proliferate because of this period of industry turmoil. Case Management Defined Several experts and health care organizations have defined case management; although, there is no standardized definition for case management (Financial, 2006).

Case management is a systematic process by which a nurse assesses clients' needs, plans for and coordinates services, refers to other appropriate providers, and met in a cost-effective manner (Allendale, Rector, ; Warner, 2010). In addition, case management serves as ways for attaining client wellness and autonomy through advocacy, education, effective communication, identification of service facilitation and service resources. Nursing case management is based on accomplishing specified patient outcomes, and is business oriented and clinically oriented Jacob ; Cherry, 2007).

Patient outcomes should be achieved within a certain time frame while using available resources as efficiently as possible to reduce costs. Case managers work to create consistent care across various levels within multiple-care delivery organizations (Park ; Huber, 2009). Case managers assist in smoothing the process of transitioning from the hospital setting to the community and monitoring them to ensure all of their service needs is being met.

Case Management Components The nurse case manager generally assumes a planning and evaluation role and collaborates with the interdisciplinary health care team to ensure that quality is maintained, goals are met, and progress toward discharge is made Jacob ; Cherry, 2007). The responsibility of a case manager is to manage a caseload from prepossession to discharge Jacob ; Cherry, 2007). Therefore, the relationship between the case manager and the client begin with the first contact. Case managers generally do not perform any direct client care duties.

Nursing case management's framework includes 5 components: assessment, planning, implementation, evaluation, and interaction Jacob &ump; Cherry, 2007). Case management begins with an assessment of the client and the situation. Some factors assessed include the client's history, current status, cognitive and functional states prior to admission, determine potential for overuse or underused of resources, and potential barriers to charges Jacob ; Cherry, 2007) Case managers then formulate the client plan, considering needs and .

Plans include.... Case Management Related to Other Nursing Care Delivery Models Nursing case management does not take the place of the nursing care delivery model in place to provide direct patient care, but 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 he 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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