Case Study Management Programs Are Concerned With Reducing Costs And Improving The Quality Of Care

Case management services include coordination of health care services with the primary care physician, specialists, and other health care providers to better monitor and provide for a patient’s health care needs. The case managers help to assimilate information about community resources and Kaiser Permanente programs. They also provide disease management when needed. Case managers can assist the patient and their caregivers to understand the patient’s health coverage for medical equipment and services. They also assist with follow-up treatment plans after discharge. These case management services are delivered while maintaining the patient’s privacy, confidentiality, health,

Moore and colleagues (2009) defines Case Management as an approach to practice that ensures vulnerable people with multiple, complex and sometimes lifelong needs are provided with a mix of personal, health and welfare supports and services, which enable them to establish and sustain their optimal independent personal and social functioning.

Rothman, J., & Sager, J. (1998). Case Management: Integrating Individual and Community Practice (2nd ed.). Boston, MA: Allyn and Bacon.

How does case management achieve efficiencies in the delivery of health care? How does case management differ from disease management?

Case Managers have a challenging job, often dealing with patients, community agencies and facilitating their hospital discharge to the next level of care. They collaborate and communicate with the entire healthcare team and mostly with the patient during the hospitalization process. They act as support for all stakeholders to achieve positive patient outcomes. In this paper, I will be interviewing Ian Mopas, who is a Patient Care Coordinator at Kaiser Permanente in Redwood City about his education, work training, goals, and objectives as a Care Coordinator, and his responsibilities in his organization.

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

Out of the 52 recipients who reported funding medical case management as a core medical service, 88% or 46 recipients reported at least one medical case management performance measure. According to the results presented from the recipients regarding information from the medical case management performance measures: 36 recipients reported the use of medical visit frequency, 32 reported data for care plan, and 20 reported data for adherence counseling and assessment.

Case Management – Case management serves to monitor patient progress and compliance with recommended addiction treatment plans. Reports to outside parties such as courts, children’s protective services, licensing boards, and employers are provided as

As the industry continues to move away from some of the Medicare programs that were created during the Obama presidency,  the Centers for Medicare & Medicaid Services (CMS) is also pulling away from specific value-based initiatives, such as mandatory bundled payments. The CMS officially canceled two of the models that were included in the Bundled Payments for Care Improvement (BPCI) Initiative.

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

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).

The case management process consists of five parts: assessment, treatment planning, linking, advocacy, and monitoring. It is not a linear process and does not follow the order it is written up. There may be some back and forth and returning to certain points.

Stakeholders are people or groups with interest in an organization that can affect or be affected by the organization itself, its objectives, or its policies (BusinessDictionary, 2015). Each stakeholder brings their own perspective to the table based on their relationship with the organization (e.g. internal or external role), their level of experience, and their area of expertise about the subject matter they are involved with. At a high level, the list of stakeholders for any organization could include people or groups such as: customers, employees, government agencies, suppliers, unions, community resources, shareholders, and business owners. For the purpose of this assignment, I will discuss and review stakeholders relative to the

Case managers also provide support and information to patients and their families. Next, is utilization review. `Its main objective is to review each case and determine the most appropriate level of services, the most appropriate settings in which the services be delivered, the most cost efficient methods for care delivery and the need for planning of subsequent care. Other methods used for utilization and control are choice restriction and practice profiling' (Douglas, 2003, p.328).

What I understand of case management is that it helps Social Workers in helping their clients, meaning social workers take actions to manage the various aspects of cases they are working on. Case management is also a shared process of assessment, planning, facilitation and advocacy for decisions and services to meet an individual’s need through communication and available resources. Case management examines the person’s physical, emotional, environmental state, and promotes quality and cost-effective outcomes. In addition, in Case management the worker helps to empower the clients to become self-sufficient. Moreover, Case management is structure into six principles