Good Case Management: A Timeless Skill
by Karen C. Kwock, RN, CCM
As I sat down to write this article about the benefits of case management, it reminded me of an article I had written for a previous employer’s newsletter entitled, “What is Case Management? The Buzz Word of the ’80s.” So I dug it out, and as I re-read the article, I realized that basic case management is as relevant today as it was in 1989. That was 18 years ago, when I first wrote that article. So I’d like to share part of that original article with you.
Today’s hospitals are caring for an increasing number of patients with multiple chronic conditions that require continuing supervision. This trend has been influenced by advances in medical rehabilitation technology that have improved and extended the lives of handicapped, chronically ill and disabled individuals. Concurrently, cost containment measures of public and private payers are influencing reduction in the length of stay at hospitals and placing more emphasis on utilization of lower cost services.
Many hospitals are responding to these trends by improving their discharge planning process and expanding their services to include post-acute care and alternatives to hospital-based care. As a result, case management has emerged as a service model that can effectively coordinate care, assure continuity and quality, and control costs by reducing inappropriate utilization of services.
Case management is a term applied to a variety of approaches for coordinating multidisciplinary or multi-service care. Through case management, all aspects of a patient’s care are considered, including:
- The level and type of care needed by the client.
- Qualifications and particular clinical expertise of the staff.
- Duration of services for the client.
- Objectives of the client’s program.
The goals of case management are to:
- Maximize the client’s ability to function independently.
- Assure continuity of care and the use of appropriate services.
- Allocate resources efficiently.
Case management is accomplished through six basic steps:
- Identification of appropriate clients.
- Client assessment (each individual’s needs, resources, etc.).
- Care planning. Based on the assessment by a multidisciplinary team, a plan of care is developed with the approval of the physician, the client and his or her family.
- Service arrangement. The case manager implements the care plan and coordinates services.
- Monitoring and follow-up. The client’s progress is monitored through regular team conferences so any potential problems can be corrected during treatment.
- Reassessment. If there are changes in the client’s situation, a reassessment of the patient’s needs is done, and the care plan is modified.
Case management is used in the private and public sector. In the public sector, state Medicaid programs are authorizing cases to be managed. Community-based, long-term care services are considered alternatives to a nursing home. The programs operate through the Department of Health, Aging or Human Services and may be funded by the city, state or federal government. In the private sector, case management programs are operated by insurers, employers, hospitals, social service agencies and private organizations or individuals.
Oftentimes patients may feel lost in the maze of services they receive. As a case manager I help to orient the patients to the program and let them know what to expect. If they have particular concerns I will relay those concerns to the team members. Although the duties of a case manager are challenging, the reward is seeing a client successfully become a productive individual again. When that occurs, we really have four happy customers — the client (patient), insurance company, employer and referring physician. That’s case management at its best.
My previous work setting was a private not-for-profit rehabilitation hospital. I currently work in a specialty clinic of a hospital-based HMO, and my case management colleagues come from a variety of settings, such as private case management, insurance companies, social service agencies, vocational rehabilitation agencies, hospital-based facility, federally funded programs, etc. We’re all doing case management. The settings may be different, the players and team members may vary, but the basic skills of a good case manager never change.
