Case Study Management Programs Are Concerned With Reducing Costs And Improving The Quality Of Care

Case managers also provide support and information to patients and their families. Next, is utilization review. `Its main objective is to review each case and determine the most appropriate level of services, the most appropriate settings in which the services be delivered, the most cost efficient methods for care delivery and the need for planning of subsequent care. Other methods used for utilization and control are choice restriction and practice profiling' (Douglas, 2003, p.328).

Case Managers have a challenging job, often dealing with patients, community agencies and facilitating their hospital discharge to the next level of care. They collaborate and communicate with the entire healthcare team and mostly with the patient during the hospitalization process. They act as support for all stakeholders to achieve positive patient outcomes. In this paper, I will be interviewing Ian Mopas, who is a Patient Care Coordinator at Kaiser Permanente in Redwood City about his education, work training, goals, and objectives as a Care Coordinator, and his responsibilities in his organization.

Case management services include coordination of health care services with the primary care physician, specialists, and other health care providers to better monitor and provide for a patient’s health care needs. The case managers help to assimilate information about community resources and Kaiser Permanente programs. They also provide disease management when needed. Case managers can assist the patient and their caregivers to understand the patient’s health coverage for medical equipment and services. They also assist with follow-up treatment plans after discharge. These case management services are delivered while maintaining the patient’s privacy, confidentiality, health,

How does case management achieve efficiencies in the delivery of health care? How does case management differ from disease management?

In my interview with Stacy she says, “A case managements goals was to meet the needs of the individuals and the families” (Downing, 2015). It all ultimately depended on the situation and how long you have known the family that you typically access the patients and use those challenges to develop a plan in which the patient has helped you formulate. The goal is to in a therapeutic way engage the patient and their families in their own plan or progress in which working within their skill level and readiness to change and build upon the current

According to an article published in Case Management Advisor (2008), education assists case managers with being as knowledgeable as possible to identify and coordinate all the resources that their patients need and continued education is an ethical responsibility of a case manager. The article also suggests that advocacy is an ethical responsibility of a case manager. When advocacy is forgotten ethical issues occur. Fraser and Strang (2004) explain that case managers must be given the tools to allow them to function in their role with confidence and competence to act as strong advocates for their patients. Support for decision making is also a key component of case management. Coffman (2001) offers key points from The Code of Professional Conduct for Case Managers advising that case managers are guided by the principle of autonom. Case mangers achieve autonomy through advocacy. If case managers are expected to function with complete autonomy, then case managers require the assusrance that their leader ship will support them when difficult decisions have to be made, (Fraser and Strang, 2004). The concept of employer employees explains that by involving employees in developing the mission and values of the company, this allows employees feel empowered (Porter-O’Grady & Malloch, 2007). By allowing the case manager to be part of the development of the

The case management process consists of five parts: assessment, treatment planning, linking, advocacy, and monitoring. It is not a linear process and does not follow the order it is written up. There may be some back and forth and returning to certain points.

Case management is a continuous balancing act of judgment calls, making ethical choices, getting along with coworkers, and following legal protocol. It is the duty of the case manager to know how to develop a relationship with both clients and coworkers while still maintain their professionalism. The healthcare professional must always leave their personal opinions at home and provide the same quality of care to all their clients regardless if they have different views, religion, sexual orientations, or cultures. The case manager needs to ensure that the client’s concerns will be put first no matter what, and should also clarify that the as the professional he or she will do all that is necessary to provide the best quality of care to their client.

Rothman, J., & Sager, J. (1998). Case Management: Integrating Individual and Community Practice (2nd ed.). Boston, MA: Allyn and Bacon.

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 organization is recognized as external case management (Jacob & Cherry, 2007). Hospitals recognized the need for the case management model in the mid-1980s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007).

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

As the industry continues to move away from some of the Medicare programs that were created during the Obama presidency,  the Centers for Medicare & Medicaid Services (CMS) is also pulling away from specific value-based initiatives, such as mandatory bundled payments. The CMS officially canceled two of the models that were included in the Bundled Payments for Care Improvement (BPCI) Initiative.

What I understand of case management is that it helps Social Workers in helping their clients, meaning social workers take actions to manage the various aspects of cases they are working on. Case management is also a shared process of assessment, planning, facilitation and advocacy for decisions and services to meet an individual’s need through communication and available resources. Case management examines the person’s physical, emotional, environmental state, and promotes quality and cost-effective outcomes. In addition, in Case management the worker helps to empower the clients to become self-sufficient. Moreover, Case management is structure into six principles

Case Management – Case management serves to monitor patient progress and compliance with recommended addiction treatment plans. Reports to outside parties such as courts, children’s protective services, licensing boards, and employers are provided as

It is our job as Social workers to find and secure the right services for our clients to access. The author states that “once there have been a thorough intake and assessment, one of the next task is making sure that there is enough support to help the client complete the intervention plan” (Ward & Mama, 2006, 143) Case management is combined of many different things such as big and small tasks. Sometimes services are not the right fit for the client we need to adapt and develop a back up plan. The author states that case management is “ the corner stone of social work practice and is one of the jobs most widely available to entry level