Case Management Family Health Essay

Case Management
Case management has become the standard method of managing health care delivery systems today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States; and it has been extended to a wide range of clients (Park & Huber, 2009). The primary goal of case management is to deliver quality care to patients in the most cost effective approach by managing human and material resources. The focus of this paper is on the concept of case management and how it developed historically, the definition of case management, the components of case management, and how it relates to other nursing care delivery models.Case Management Family Health Essay

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History of Case Management
The concept of …show more content…
Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).
Hospitals felt the pinch of payment shortfalls in the early to mid-1990s resulting from the prospective payment program (Daniels & Frater, 2011). Because of this dramatic change in organizational culture which engaged hospital employees and physicians in cost savings and delivery of care efficiencies, hospital governing bodies explored the consulting world to help rein in costs and reduce the length of stay of patients (Daniels & Frater, 2011). During this time many hospitals many hospitals recognized a new financial reality and had to downsize, reduce staff, or simply close (Daniels & Frater, 2011). Hospital case management programs then began to proliferate because of this period of industry turmoil.Case Management Family Health Essay

The focus of this paper is case management. Case management has evolved into a diverse profession which includes many disciplines and is exercised in many settings. Case management involves the process of coordinating multiple services on behalf of clients and has been practiced now for several decades. Many disciplines have engaged in case management and identify themselves as case managers. Case managers work with many populations and settings and play an important role in today’s society. The following analysis explores how case management developed, how it is defined, its components, and how it relates to other nursing care delivery models. All these aspects are reviewed with the purpose to show the importance of case management

Case Management
Case management has become the standard method of managing health care delivery systems today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States; and it has been extended to a wide range of clients (Park & Huber, 2009). The primary goal of case management is to deliver quality care to patients in the most cost effective approach by managing human and material resources. The focus of this paper is on the concept of case management and how it developed historically, the definition of case management, the components of case management, and how it relates to other nursing care delivery models.Case Management Family Health Essay
History of Case Management
The concept of Case management has was first introduced in the 1970’s by insurance companies as a way to monitor and control costly health insurance claims, commonly created by a catastrophic accident or illness (Jacob & Cherry, 2007). Today almost every major health care organization has a case management program managing and directing the use of health care services for their clients. Also, case management by payer organizations is recognized as external case management.
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007).

Community health centers are public or non-profit clinic sites located in medically underserved, rural, and urban areas throughout the nation. They receive grants under the Community and Migrant Health Centers Program of the US Department of Health and Human Services to provide primary and preventive care to community residents. Community health centers remove common barriers to care by serving communities that otherwise confront financial, geographic, language/cultural and other barriers, making them different from most private, office-based practices. CHCs are:Case Management Family Health Essay

• Located in high-need areas identified by the federal and state government as having elevated poverty, higher than average infant mortality, and where fewer providers agree to practice;

• Open to all residents, regardless of insurance status, and provide reduced cost care based on ability to pay;Case Management Family Health Essay

• Tailor services to fit the special needs and priorities of local communities, and provide services based on the advice of local residents, businesses, churches, and other organizations; and

• Offer services that help patients access health care, such as transportation, translation, case management, health education, and chronic disease management.

Health centers are required by law to provide:

• Basic health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology;

• Diagnostic laboratory and radiology services;Case Management Family Health Essay

• Preventive health services including prenatal and perinatal services, immunizations, pediatric eye, ear, and dental screenings, voluntary family planning services, and preventive dental services;

• Emergency medical services;

• Pharmaceutical services as may be appropriate;

• Referral services;

• Patient case management , including counseling, referral, and follow-up services; and

• Services that enable patients to use the health center, such as outreach, transportation, and translation services.

Federal legislation also requires health centers to have governing boards with a representing the community served with a majority of the board members using the center’s services.

Who is a healthcare Financial Manager?

The healthcare financial manager is going to become more critical in determining the strategic direction of health care, especially with respect to assessing the financial impact of strategic decisions relative to managed care

What is Role does healthcare play in a community?Case Management Family Health Essay

IHC was comprised of 15 hospitals and had total assets of about $100 million. Nine years later, in 1984, we had grown to 25 hospitals and created IHC Health Plans, Inc. Today, IHC has $1.3 billion in revenue and assets. We still have the hospitals, we have health plans, and we have just created a new division that we call the Physician Division. We are bringing physician practices into our health plan and a hospital activity to form what we believe is a truly integrated system.

The future of health services is managed care, the concept that as you improve clinical quality, you lower costs. Case Management Family Health Essay

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