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 in the health care organization.
Case management has become the standard method of managing health care delivery organizations today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States; and has been extended to a wide range of clients (Park & Huber, 2009). Regardless of the setting, case management ensures that care is oriented to the client, while controlling costs at the same time. Case management delivers quality care to patients in the most cost effective approach by managing human and material resources. Client advocacy is a strong underlying theme for all case management activities. Case managers share the same goals and standards of practice, but are multidisciplinary and have diverse academic educational backgrounds and work environments (Park & Huber, 2009). The need for case management and case managers continue to increase as new service needs, and populations are recognized.
Case management was first introduced in the 1970s 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 organization is recognized as external case management (Jacob & Cherry, 2007). Hospitals recognized the need for the case management model in the mid-1980s 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). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the...