The Benefits of Medical Case Management

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January 17th, 2013
Categories: Healthcare Reform

medical case managementThrough proactive approaches, medical case management helps benefit patients, providers and payers by reducing healthcare costs, coordinating care and improving patient satisfaction.  Case Management can be defined 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 according to CMSA’s Standards of Practice for Case Management. This is accomplished through communication and available resources in an effort to promote quality and cost-effective outcome. Case management helps facilitate a more holistic approach to cost containment and their member’s care.  By proactively assessing patient needs, case managers have the opportunity to address the reasons behind improper utilization of services, make changes to avoid such occurrences and foresee potential hurdles or opportunities for cost savings. This consequently reduces costs and improves the quality of care.

By using medical case management to ensure appropriate, client-centered and effective care, the following benefits can be achieved.

1.    Reduced Costs

Case management services are a proven way to reduce duplicate testing and medications, the number of unnecessary inpatient days and hospital readmissions. By collaborating with providers and facilities, case managers keep all parties informed of patient treatment details and ensure that care is shifted to more appropriate and less costly care settings.

2.    Coordination of Care

Coordination of care between providers ensures a smooth transition from one care setting to another and promotes greater patient adherence to their care plan.  Case managers plan and coordinate the appropriate care setting necessary to handle patient’s care, which improves quality of service and has potential to improve clinical outcomes. Coordination of care also includes communicating information between providers and patients that they may otherwise not have access to. In other words, closing the so-called ‘care-gap’.

3.    Improved Patient Satisfaction

Case management provides patient education as one of its core guiding principles to facilitate patient independence and self-care.  Patient education may cover what to do in various instances to when a condition worsens or it is necessary to seek emergency care. For example, distributing quick reference guides to new mothers about what to do when their child becomes ill can reduce number of ER visits. Support from registered nurses help alleviate patient concerns that may to lead to unnecessary medical care. Patient satisfaction is greatly increased when more effective, personalized care is given.

For more information on what case management entails, please read our post, Case Management Explained.