Case Management
What? Who? Why? Areas of activities Contents
What? Managing cases which are expected to result in very large costs. To provide coordination of care. Result in both proper care and cost saving. Addresses the inpatient cases.
What? Collaborative multidisciplinary process.. Asses, plans, implements, co-ordinates, monitors and evaluates the options.. Using communication and available resources to promote quality and cost effective outcomes..
Who? Case managers Coordinator of care Problem solver Facilitators and educators
Who? Usually a registered nurse. Are UM staff members. Case managers are either: 1- assigned by the hospital. 2- assigned by the MCO. 3- Independent, assigned by the patient or his family.
Why? Most healthcare costs are generated by 3-5% of patients; those who are at high risk, critically injured or suffering from a chronic disease.
Successful case manager!!! Help the patient to maximally use benefits. While keeping within any coverage limitations. ( win – win outcome) It is the responsibility of the case manager to negotiate for the most cost – effective care while maintaining quality of services and achieving optimal patient outcomes
Save money 1:3 up to 1:30 Discuss options and solicit preferences and matches them with the post acute level of care needs and with the insurance benefits for which the patient is eligible!
Areas of Activity Medical Financial Behavioral Vocational Psychological support for the patient and family and explaining the patient’s condition and special needs -Assessment of patient’s condition when admitted and discharge planning Assessing the patient’s benefit plan for coverage and limitations and suggesting more cost-effective alternative Completing a job analysis and discussing the possibility of the patient’s return to work in the same job
Thank You!