Case management principles and practices

¶ … Management History- Case Management Society of America, (2010). "Definitions of and History of Case Management in Health Care Settings." Cited in: http://www.cmsa.org/Default.aspx?tabid=104

Medical case management is part of the managed care technique within the American health care system. It is collaborative, and included planning, advocacy, and facilitation for particular clients through the case manager's network of resources. At its best it is multidisciplinary and cross functional, able to monitor and offer appropriate services and care to clients who are in need. At worst, it can be a difficult set of bureaucratic hurdles in which often the "squeaky" wheel is top of mind for care. The key for case management, however, is collaborative. In the United States, a CCM (Certified Case Manager) credential is available for health care providers licensed to practice within a multifaceted, and sometimes fragmented, health care system. To receive certification candidates must pass a rigorous examination, similar in content and difficulty to State Board exams for nurses. Within the system, case management focuses on four basic templates which are designed to deliver personalized services to patients in need: 1) Referral of new patients or clients new to area or care, 2) Specialized individual plan and delivery of care, 3) Continual evaluation of care plan -- regular adjustments, and 4) Evaluation of the overall program's effectiveness and appropriateness of care. Case management became necessary after the 1973 "Health Maintenance Organization Act," when medical and insurance professionals realized that in order to provide even adequate care personalized case management would be required. And, as the projected demographics of the nation showed an increasingly aging population, even more so in the ensuing decades.

Certification and Qualifications of Case Managers- Haley, J. (2007). "Experience Shown to Affect Communication Skills of Nurse Case Managers." Care Management Journals. 8 (2): 50+.

Case management certification is a robust program that goes beyond clinical healthcare and requires that the participant understand the voluminous amounts of interaction that must take place within the contemporary health care system. It is appropriate for Registered Nurses or RNs with a social work background. The CCM is complex enough than and LPN is not yet ready -- the CCM must be able to be licensed to assess and evaluate the health of clients, both in a clinical and chart-based system. Within the framework of case management, research shows that about 30% of time is spent on teaching the client to gain autonomy and responsibility in decision making for their own health care. Thus, not only is it essential that the CCM be medically trained, and then trained in insurance and multidisciplinary health care issues, but that they have exceptional communication skills. This study found, in fact, that the success of CCMs is directly linked to communication style and abilities -- in particular, the ability to provide a strong but professional advocacy role for the patient.

Acute Care Case Management Models -- Chernesky, R. And B. Grube. (2000). "Examining the HIV / AIDS Case Management Process." Health and Social Work. 25 (4): 243+.

The HIV / AIDS population is already a population at risk for a number of reasons: health issues, availability of pharmaceuticals, costs of care, access to care, inability to work, the social welfare system, and still vast misunderstanding and prejudices. In order to adequately assist this population with the basic aspects of daily living, regardless of disease diagnosis or prognosis, a robust an ongoing case management protocol is essential. These clients tend to present while in crisis, so if a protocol and rubric is already established, the quality of care is certainly increased. The critical place of the HIV / AIDS case manager is as a direct service hub, in which the relationships and networking abilities of the case manager are allowed to come to the forefront to aid this population base, and to increase the cross-functional understanding of said group as well. This educational aspect is of the upmost importance, and goes far beyond the clinical aspect of chart review. The authors encourage case managers who have HIV / AIDS patients to make an active effort to move beyond the patient as a number in their load, and understand that these individuals are often so disenfranchised that they so need a medical advocate. In most cases, by the time the case manager becomes involved, the individuals are either so traumatized or so ill that they are most certainly not able to advocate for themselves.

Clinical Pathways and Other Structural Methods Used By Case Managers -- Roberts, R., et.al. (2007). "A Service Model of Short-Term Case Management for Elderly People at Risk of Hospital Admission." Australian Health Review. 31 (2): 173+.

One of the larger and increasing costs to case management services is in the gerontological population. This group has more frequent, albeit shorter, hospitalizations. Sometimes, because of the number of admissions, certain aspects of professional case management theory fall by the wayside. This research suggests that the short-term case management model has a significant contribution to make in preventing unplanned hospital visits and admissions. If the case model is followed correctly, for example a multidisciplinary, open communication, multilocation model of aggressive intervention, then a number of short-term admissions may be curtailed. In fact, if the case manager is aggressive in targeting risks, screening potential glitches in the system, and has experience dealing with geriatric advice and diagnosis, they may hold the key to an effective preventative approach to healthcare for this population. This is especially important given that in almost every country, there is a significant increase in the aging of the population, placing far more stress on the healthcare segment than ever before. As one prepares for the future of case management, it is important to note that the greater the collaborative skills and multidisciplinary and multiagency approach, the better the program works for all stakeholders involved.

Insurance Case Management Models -- Weir, S., et.al., (2008). "Case Selection for a Medicaid Chronic Care Management Program." Health Care Review. 30 (1): 61+.