Case Management Flashcards
Historical Perspective on case management
- over a century old
- contemparily started 1970s by insurance companies to provide quality outcomes and cost containment in a complex health system
Major health insurance companies started to use case managers….
to direct and manage the utilization of health care services
Medicare’s implementation of DRGs reimbursement influenced…
diagnosis related group
-the adoption of case managers in the hospital setting
The underlying premise of case management..
based on the fact that when an individual reaches the optimum level of wellness and functional capability, everyone benefits, the individuals being served, their support systems, the healthcare delivery systems and the various reimbursement sources
Definition of case management
- means different things in different settings
- member of multi-disciplinary team
- collaborative process of assessment, planning, faciliation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes
Purpose of case management
- maintain QUALITY care while streamlining costs
- provide and coordinate HC services
- a “defined” population
- dynamic and systematic
- collaborative approach
Goals of case management
- decrease fragmented and duplicated care
- enhance quality cost-effective clinical outcomes
- efficient care-decrease length of stay (LOS)
Case managers are responsible for…
the review of the entire hospitalization of care from admission to post discharge
The role of CM are necessary…
under increasing pressure to deliver faster and more efficient care with better outcomes
