Case Management (USA Health System) - Case Management in Health Care

Case Management in Health Care

The American Case Management Association, a non-profit association dedicated to the support and development of the profession of case management through educational forums, networking opportunities, legislative advocacy and establishing the industry's Standards of Practice, defines case management as:

"a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality costeffective outcomes."

Case Management is multifaceted as the following definition highlights:
"Case management is a procedure to plan, seek, and monitor services for different social agencies and staff on behalf of a client. Usually one agency takes primary responsibility for the client and assigns a case manager, who coordinates services, advocates for the client, and sometimes controls resources and purchases services for the client. The procedure allows many social workers in the agency, or in different agencies to coordinate their efforts to serve a given client through professional teamwork, thus expanding the range of needed services offered."

The Certified Case Manager (CCM) credential is available to health care providers licensed to practice independently in the American health care system. For example, the license would be available to Registered Nurses but not Licensed Practical Nurses, who are not licensed to assess and evaluate the health of their clients.

Because holistic training is the basis for the Registered Nurse, Social Work, Occupational therapy and most all degree programs in the health sciences, the transition into case management is a natural progression of skill. To investigate if your specialty is among those able to earn this specialty certification, go to http://www.ccmcertification.org/secondary.php?section=Certification&content=ApplyForCertification, and read the requirements for application for this certification.

Case management focuses on delivering personalized services to patients to improve their care, and involves four steps:

1) Referral of new patients (perhaps from another service if the client has relocated to a new area out of previous jurisdiction, or if client no longer meets the target of previous service, such as requiring a greater level of care. Alternatively, they may be referred after having been placed on an ITO or in an inpatient unit.

2) Planning & delivery of care

3) Evaluation of results for each patient & adjustment of the care plan

4) Evaluation of overall program effectiveness & adjustment of the program

In the context of a health insurer or health plan it is defined as:

A method of managing the provision of health care to members with high-cost medical conditions. The goal is to coordinate the care so as to both improve continuity and quality of care and lower costs.

Specific types of case management programs include catastrophic or large claim management programs, maternity case management programs, and transitional care management programs.