Case Management Essay Example | Topics and Well Written Essays - 750 words

Case Management - Essay Example This system has five (5) essential features: (1) Identification of eligible patients, (2) Assessment, (3) Development of an individual care plan, (4) Implementation of care plan, and (5) Monitoring of outcome. In brief, case management can be delivered as a single intervention or as part of a multi-component intervention (Guide to Community Preventive Services, 2002). Some of the factors that increases interest in case management includes the rapidly escalating population of managed care contracts and the increase of patients who are chronically ill and require continuous costly care. The ability to capture and maintain appropriate information to allow high levels of collaboration between care managers, financial managers and payers are crucial in case management. Combining clinical and financial records is necessary in developing an effective case management program (Cerner & HFMA, 2006). Efforts in controlling healthcare quality and cost need to be an absolute commitment from both governance and senior leadership that balances approach to quality and financial outcome. Case management is a part of an overall process of improving the quality of care provided by an organization. It needs active engagement and passion of senior leaders because separation between business goals and clinical goals must be eliminated.The physician who functions as a medical director, a nurse who functions as a full time clinical officer or case manager and a hospital administrator should set clinical improvement goals together and discuss how to best manage quality health care. Accountability must be established and designed to review clinical and financial outcomes. However, providing sound clinical and financial information in timely manner is essential to the process. Electronic medical records revolutionize health care due to the availability of evidenced-based protocols and pharmaceutical applications that gives easy access to practitioners the best research on a specific disease condition. Most hospitals have computerized electronic hospital information system that helps administrators collect and analyze financial data and electronic medical records for clinical data. But the two systems are not linked. Combining the data from both systems is seen as a necessary ingredient in effective clinical and financial case management A combined system can also schedule appropriate resources needed to provide services. These electronic systems help case managers streamline the process of verifying the level of care the patient requires and the willingness of the his insurance carrier to reimburse the hospital for that care (Yoder-Wise, 1999). Scientific studies continue to document that poor care is being delivered despite significant amount of money spent in providing care service. Ineffective and inconsistent care leads to bad outcomes and higher costs due to the absence of an organized approach to management (Harrison, Nolan, & Sucro, 2004). Some experts state that case management improves the quality of care by