Introduction
The presented YouTube Video shows conclusively that Case Management (CM) is a powerful philosophy that benefits many people in the healthcare setting (Phillips, Han, Petterson, Makaroff, & Liaw, 2014). The ultimate goal of CM is “to ensure the targeted patient reaches the option level of functional capability and wellness” (Mullahy, 2014, p. 18). That being the case, CM should be implemented as a collaborative process aimed at planning and evaluating the available services to address the health needs of more patients. This goal can be achieved through provision of resources and positive communication. This discussion addresses the major issues associated with the CM philosophy.
Case Management: Reducing Costs or Improving Quality of Care?
Many health institutions have implemented a wide range of quality assurance (QA) programs in order to support the diverse needs of their patients. Case Management happens to be one of these QA programs. This fact explains clearly that CM plays a critical role towards improving the quality of care available to different patients. This concept is implemented to achieve client autonomy and wellness (Phillips et al., 2014). This goal can only be realized through effective communication, provision of resources, education, and advocacy. Healthcare institutions create the position of a case manager in order to support the diverse needs of the targeted patients.
The role of the case manager is to liaise with different workers and facilities throughout the healthcare delivery process. This process is executed throughout the care process (Moreo, Moreo, Urbano, Weeks, & Greene, 2014). The manager goes further to identify and avail the best resources in order to treat more patients. This practice is used to ensure the resources are utilized in a cost-effective and timely manner. Direct communication between the client and case manager is encouraged to maximize health results. The process of CM is undertaken using six steps. These steps are considered in order to ensure every admitted patient benefits from the services available at the health institution. After admission, appropriate measures are considered in an attempt to deliver quality services.
Case managers identify the existing gaps in service delivery and propose the most appropriate practices. Referrals are made depending on the issues experienced during the care delivery process. This discussion therefore supports the fact that the ultimate goal of case management is to improve the quality of care. The process is undertaken to ensure the available resources are matched with the unique needs of the client (Collins, Jarrah, Gilmartin, & Saya, 2014). This move is undertaken to reduce costs and minimize time wastage. That being the case, cost reduction is one of the aspects of case management. The aspect also plays a positive role towards improving the quality of patient care.
Limitations and Strengths of a Typical Case Management Program
A typical Case Management (CM) program is characterized by six phases or stages. The first stage undertaken in a typical CM program is the identification of the targeted client. This is followed by opportunity identification and development of the most desirable CM plan for the patient. The next stage is the continued provision and coordination of care. Follow-up and evaluation is undertaken to monitor the progress of the client. The final stage focuses on the best processes to terminate the plan. This model therefore makes it easier for healthcare facilities to admit patients who can benefit from their care models (Moreo et al., 2014). The program is used to allocate the best resources that can support the health needs of the targeted patients.
Experts have supported the model because it is capable of improving the quality of care. Unnecessary costs are reduced throughout the process. The case manager evaluates the duties undertaken by different caregivers in order to maximize the outcomes of the targeted patients. The program makes it easier for institutions to refer their patients whenever the situation gets out of hand (Collins et al., 2014). These strengths explain why more hospitals will continue to embrace the program in the future.
On the other hand, the model is characterized by a number of limitations. For instance, the program must be extended in order to support the health needs of patients with terminal conditions. This means that the typical program might not support the provision of long-term care. In some hospitals, Case Management is implemented to reduce expenses or costs. This kind of strategy makes it impossible for such institutions to offer quality care (Collins et al., 2014). The program can be costly for small hospitals.
Some experts have also argued that the program “ignores the emotional, spiritual, and psychological aspects of a patient” (Hendricks et al., 2014, p. 266). The method can fail to deliver comprehensive treatment because it focuses on the issue of care (Moreo et al., 2014). The model fails to offer long-term competencies that can help more patients to deal with various health problems. This fact explains why “many scholars have proposed a wide range of strategies such as the use of evidence-based interventions to offer quality care that is in accordance with the meta-paradigms of nursing” (Mullahy, 2014, p. 59).
The Future of Case Management Programs
The current evidence regarding the use and effectiveness of case management is overwhelming. This fact explains why many leading health institutions such as Mayo Clinic and Houston Methodist have implemented powerful Case Management Programs. The inclusion of such programs as part of their QA initiatives is something that has made the facilities leading providers of exemplary patient care (Hendricks et al., 2014). This program has the potential to guide and empower more caregivers to support the changing needs of their clients.
This evidence shows conclusively that more institutions in the healthcare sector will continue to embrace the power of Case Management. This model has been observed to make a difference for many facilities and improve the health outcomes of more patients. The CS program has been observed to improve the level of healthcare quality. Resources are also utilized efficiency in an attempt to minimize wastes (Phillips et al., 2014). The model is used by institutions that want to monitor their patients throughout the admission period. New improvements and care delivery processes are implemented in order to produce desirable results.
The model has therefore made it easier for more healthcare institutions to realize their potentials. This analysis shows clearly that CM programs will become relevant in the future. More institutions are expected to embrace these medical programs in order to improve the quality of medical care to their patients (Hendricks et al., 2014). Since quality assurance is a framework that guides the performance of many hospitals, the inclusion of CM programs will play a positive role towards delivering positive results (Collins et al., 2014). The strengths of CM should be embraced by more healthcare institutions that want to support the changing needs of their patients.
Medical institutions planning to implement the CM program will have to consider some of the limitations associated with it. This strategy will make it easier for them to identify new measures that can improve the health outcomes of more patients. For instance, the institutions should ensure the major steps of the CM model address the emotional, spiritual, and psychological needs of the targeted patients. The approach will ensure the concept of wholistic care is taken seriously (Hendricks et al., 2014). The strategy will play a positive role towards addressing the diverse health needs of more people in the community.
It will be appropriate for more institutions to use the model to support the needs of patients with terminal diseases. This model should be expanded in such a way that it supports the health needs of individuals who have been discharged from their respective hospitals (Collins et al., 2014). Many experts believe strongly that more hospitals will use multidisciplinary teams and social workers to empower more patients. This analysis shows clearly that the CM program will become a medical necessity in the future.
Importance of “Gatekeepers” for the Case Management Process
Case managers act as gatekeepers to the CM process. This role explains why they should possess the most desirable competencies and skills. These managers play a critical role because they combine all the functions of different professionals such as nurses, physicians, and caregivers. They offer numerous contributions in an attempt to maximize the quality of healthcare available to the targeted patients. As gatekeepers, these case managers work hard to improve the outcomes of the targeted clients (Hendricks et al., 2014). They achieve this goal by ensuring that the existing health systems in an institution are capable of supporting the needs of more clients.
Readmission is a major risk associated with healthcare delivery. Many patients tend to be re-hospitalized due to hospital-related infections or medication errors. These case managers therefore promote coordination and eliminate gaps that might result in unnecessary readmissions (Hendricks et al., 2014). This practice plays a significant role towards minimizing the costs incurred by many patients.
The other unique duty of a case manager is “to enhance claims management” (Mullahy, 2014, p. 42). This process is critical towards ensuring that the period of stay in the hospital is not custodial. This approach makes it easier for medical facilities to use their resources adequately to address their patients’ health needs. The manager liaises with different stakeholders to support the diverse needs of more patients in the targeted society.
These gatekeepers have been observed to promote a wide range of strategies that have the potential to maximize the outcomes of more clients. Desirable right skills and resources are mobilized in order to improve the quality of patient care. The case managers use their competencies to implement and promote the best healthcare delivery processes. These initiatives therefore play a positive role towards minimizing risks while at the same time improving the quality of care available to more patients in the hospital (Phillips et al., 2014). Case managers in different hospitals should therefore consider these roles and strategies in order to support the changing health demands of their respective clients. This practice will eventually ensure more health institutions realize their objectives.
References
Collins, D., Jarrah, Z., Gilmartin, C., & Saya, U. (2014). The costs of integrated community case management (iCCM) programs: A multi–country analysis. Journal of Global Health, 4(2), 1-16.
Hendricks, V., Schmidt, S., Vogt, A., Gysan, D., Latz, V., Schwang, I.,…Riedel, R. (2014). Case management program for patients with chronic heart failure: Effectiveness in terms of mortality, hospital admissions and costs. Deutsches Ärzteblatt International, 111(15), 264–270.
Moreo, K., Moreo, N., Urbano, L., Weeks, M., & Greene, L. (2014). Are we prepared for affordable care act provisions of care coordination: Case managers’ self-assessments and views on physicians’ roles. Professional Case Management, 19(1), 18-26.
Mullahy, M. (2014). The case manager’s handbook. Burlington, MA: Jones & Bartlett Learning.
Phillips, L., Han, M., Petterson, M., Makaroff, A., & Liaw, R. (2014). Cost, utilization, and quality of care: An evaluation of Illinois’ Medicaid Primary Care Case Management Program. Annals of Family Medicine, 12(5), 408–417.