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.,...
"Case Selection for a Medicaid Chronic Care Management Program." Health Care Review. 30 (1): 61+.
It is clear that health care costs in the United States will not decline or even align in the foreseeable future. As health costs continue to skyrocket, Medicaid programs are faced with several challenges. They must provide appropriate health care for a vulnerable population and yet continue to contain costs or face severe rebuke from a watchful public and government. Some of the attempted solutions of direct control, like limiting eligibility or access to needed services, usually produce only minor, and very temporary, budgetary relief. In fact, it may actually cost the public more to "save" money on Medicaid and have the more serious cases end up in the Emergency Room. Instead of cutting programs for the top chronic diseases, this research suggests the using a particular case management model, the ACG-PM model, typically outperforms other models in terms of its sensitivity, manner of specificity, and the way it can predict cost threshold (with a +/- 10% margin of error). Essentially, this model combines a number of sensical indicators and preventive care so that chronic disease does not typically get out of control and end up with lengthy hospital stays, costly procedures, and far more time involved in the medical model. In the example of diabetes, for instance, the research found that if regular and strict care was provided, patient's medications and treatments authorized, and regular (at least quarterly) visits to the primary care physician approved, there was a far less chance that the patient would use critical care measures to the extent of a control population. One limitation may be in size and human resource issues managing the typical caseload. The research was conducted in Vermont, admittedly a rather small State with a smaller percentage of patients that fit the serious criteria as some other larger, more urban, areas. Additionally, one serious variable in the research is the factoring of emergency situations, which…
