In health care, case management is a procedure that links patients with healthcare physicians, resources, and services. In order to ensure that patients receive the best possible care, case management necessitates case managers to navigate various healthcare systems and work with stakeholders such as patients, medical experts, and health insurers.
This article will teach you more about case management, its procedure, and several case management approaches. In the end, you can find more materials and courses to help you gain a better grasp of case management.
What is Case Management?
The definition of case management is the planning, processing, and monitoring of healthcare services provided to a patient by a coordinated group of healthcare practitioners. Case management is intended to meet a patient’s needs while controlling costs, with a case manager keeping track of a patient’s outcomes. A case manager may be assigned to a specific patient by insurance companies, hospitals, or outpatient care providers.
Case management, also known as dynamic case management, is typically performed by healthcare professionals with expertise working in a medical setting such as a hospital.
How Case Management Works
What is your definition of case management? There are several options. A medical professional, for example, managing an individual’s needs is not dissimilar to a financial advisor managing a client’s portfolio. Case managers assess a patient’s needs and decide the most efficient way to deliver care given available resources.
Case managers try to keep expenses as low as possible because they work for health insurance companies, hospitals, and other providers. With escalating healthcare expenditures, case management can be a helpful tool for both consumers and businesses.
When a new case is established, a case manager examines what services are regarded medically essential and works with various service providers to ensure that the required services are provided in the right setting. Case managers must handle complex care demands, which may involve several services provided at various times by various healthcare providers.
Working with insurance carriers to ensure that operations and services fall under policy coverage and are paid for is part of hospital case management. It also includes teaching patients about lifestyle changes, medication administration, and when to return for follow-up consultations. To follow up with patients, case management in a rehabilitation center, for example, would involve mental health service professionals.
Focused case management is designed for a specific set of patients who require continuing care, such as those suffering from chronic mental illness or impairments.
Case Management Processes
Case management is a collaborative process in which a case manager works with clients to ensure they receive the best possible healthcare services at the lowest possible cost. This is how the process usually goes:
- Screening: The case manager evaluates a client’s medical records, medical history, and current financial, living, and social support situation to understand the client’s needs and present circumstances.
- Assessment: The case manager performs more research and meets with the client to examine their medical condition and circumstances. They may examine the client’s health insurance, support systems, and treatment response history.
- Risk assessment: The case manager assesses the client’s risk for specific ailments during this step. Existing physical issues, blood pressure, mental health, and finances are all common factors considered.
- Planning: A case manager produces a plan of care for their client during the planning stage, which includes their health objectives, self-care goals, health care options and services, care schedule, and any applicable resources.
- Implementation: Once a plan has been developed, the case manager assists the client in putting it into action by directing them in attending appointments and educating them about health-related topics.
- Follow-up: At the follow-up stage, the case manager checks in with the client, their healthcare providers, and their personal support network to see how they are moving through their treatment plan. The case manager may suggest modifying the treatment plan if necessary.
- Assessing results: Lastly, the case manager reviews the entire case and evaluates its outcomes, such as the client’s well-being, money, and whether they received proper care.
Different Case Management Models
The three case management models listed below can be modified or updated to meet the specific requirements of a hospital or health organization. These customizable models can be utilized in a number of case management situations for a wide range of people.
#1. Brokerages Case Management Model
In the brokerage case management model, a case manager assesses a client’s need and then acts as a broker, connecting them with the appropriate resources, services, and medical professionals. Normally, case managers in this system have limited personal contact with the client, functioning as a liaison to ensure they receive the care they require. This methodology emphasizes linking customers with medical specialists who will monitor outcomes rather than monitor outcomes.
#2. Clinical Case Management Model
A case manager (typically a therapist or counselor) is assigned by a clinical care provider in the clinical case management approach. The case manager works directly with the client in a clinical role, providing care as well as coordinating and formulating treatment programs. Such direct involvement can improve the client’s health outcomes and motivate them to adhere to their care plan more closely.
#3. Strength-based Clinical Case Management
The strengths-based clinical case management paradigm is focused on empowering clients and their support networks to achieve their health objectives. This strategy, in effect, promotes psychological and emotional empowerment by reframing internal narratives, as well as social empowerment by altering external constraints that may be holding clients back. Although it was first designed for those suffering from serious mental illnesses, this paradigm can be applied to a wide range of clients with varying needs.
#4. Intensive Case Management
Intensive case management is intended to provide services to a patient as rapidly as possible through one-on-one meetings with the manager, who frequently accompany the patient to sessions and appointments to ensure rehabilitation goals are reached. Of all the approaches, intense case management provides the most particular care to patients, and case managers are actively involved in the rehabilitation process.
Case Management Skills
Being a case manager demands both technical healthcare expertise and good interpersonal abilities. Case managers should have the following common skills:
- Medical knowledge of a wide range of disorders
- Understanding of the healthcare system, including various medical specialists, medical organizational structures, and health insurance providers
- Coordination and project management
- Communication Empathy
- The capacity to work with others
Examples of Case Management
An older patient who has just suffered a stroke may be appointed a case manager at their hospital to ensure they receive the necessary follow-up treatment. In this case, the case manager would serve as a go-between for the patient and their health insurer. They would examine the patient’s current support network, recommend rehabilitation clinics, and point them in the direction of more resources. Throughout time, they would monitor the patient’s development and ensure that they attended their medical visits and took any recommended medication.
Case Management Certification
To achieve your case management certification, you must meet the prerequisites required to sit for the certification exam. According to the Commission for Case Manager Certification, in order to take the CCM exam, you must have at least 30% qualified work time with a concentration on case management practice. You must also hold a current, active, and unrestricted license or certification in the field of human services or health.
So, everyone wishing to take the certification exam must possess the necessary educational credentials. You must, for example, have a bachelor’s or graduate degree in social work, nursing, or another health or human services field.
Case Management Examples
Example 1
River was in a bad bike accident and had a catastrophic brain injury, as well as a fractured arm and femur bone. Their lives were difficult to manage because their impairments had an influence on both their physical and cognitive capacities. To ensure that therapy went well, a clinical case management model was employed, and the case worker assigned developed a care plan.
The case manager scheduled them for physical therapy, neuropsychology, and occupational therapy sessions, coordinated appointments, met with them on a regular basis, including phone check-ins, and assisted them with financial planning. The caseworker might carefully construct River’s rehabilitation plan and provide River with direct attention to help them fully recover by maintaining consistent contact and assisting River with their appointments.
Example 2
An older patient who has just suffered a stroke may be appointed a case manager at their hospital to ensure they receive the necessary follow-up treatment. In this case, the case manager would serve as a go-between for the patient and their health insurer. They would examine the patient’s current support network, recommend rehabilitation clinics, and point them in the direction of more resources. Throughout time, they would monitor the patient’s development and ensure that they attended their medical visits and took any recommended medication.
What is Case Management in Social Work?
In social work, case management refers to how a professional social worker analyzes and advises a client and their family. A social worker may manage a case by making home visits, assisting a client in enrolling in the social services they require, and following up with a client and their family after an evaluation.
What is Case Management in Nursing?
In nursing, case management refers to the process by which a nurse follows up with a patient to ensure that they receive the necessary care and rehabilitation to recover.
What is a Case Management Software?
Case management software is an online program that is used to keep track of patients, cases, appointments, and other data that case managers and their employers require for their files.
What is a Targeted Case Manager?
The Centers for Medicare & Medicaid Services defines targeted case management as supporting certain groups, such as individuals with chronic mental illness or developmental impairments, in receiving the services they require.
Who is a Case Manager?
A case manager is typically a nurse, social worker, or healthcare administrator who has been trained to assess treatment needs, develop and evaluate treatment plans, act as a liaison between clinicians and patients, monitor rehabilitation, review records and applications, and assist new case managers.
Conclusion
When it comes to case management, there is rarely a one-size-fits-all strategy for patient rehabilitation. So it is critical for case managers to use multiple case management models based on the injury or sickness. A case manager with a solid background in healthcare will be better able to assist a wide range of persons by knowing how to adopt diverse types of case management.
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