Case management is defined as a health care process in which a professional helps a patient develop a plan that coordinates and combines the support services that the patient needs to optimize the healthcare and psycho-social possible goals and outcomes. It appeared in the early 1900s in response to a need for more integrated care across health and social services, particularly for those in vulnerable situations such as people with severe mental issues and veterans returning home with complex injuries.
Case management arose through social work and did not become part of the nursing profession until the middle of the 20th century.
The workflow of a case management process can be broken down into seven levels:
- Screening.
- Assessing.
- Evaluating risks.
- Planning.
- Implementing.
- Following up.
- Evaluating outcomes.
The goal of case management is to integrate care with cost-effective approaches to provide safe, timely, efficient, effective, and equitable care. Professionals from health and other fields collaborate to optimize population health through integrated care models that maximize efficiency and minimize costs.
Types of Case Management Models
The Strengths-Based Clinical Case Management Model: is based on the strengths of the client, and considers their personal needs, goals, and helps the client incorporate all their strengths (including community, family, friends, and home environment) to create a plan of care.
The Clinical Case Management Model: creates a plan using a combination of services from physical therapy to mental health resources, The case manager using this model works hands-on to ensure the patient is utilizing all therapies, and they meet regularly with the patient to discuss ongoing care.
The Brokerage Case Management Model: focuses on the delegation of services to a patient after an assessment. Case managers using this model provide access to the services needed, but they do not interact frequently with a client other than put together their rehabilitation plan and schedule.
Intensive Case Management: is designed to deliver services to a patient quickly with one-on-one meetings with the manager who often accompanies the patient to sessions and appointments to ensure rehabilitation goals are met. Out of all the models, intensive case management gives patients the most individual attention.
Nowadays, insurance companies, insurance brokers & hospitals may assign a case manager to monitor a particular patient. Case managers are healthcare professionals who serve as patient advocates, supporting, guiding, and coordinating care for patients and families as they steer their health and wellness journeys. They serve as the center of communication and helps identify appropriate providers and facilities throughout the series of services. They also make sure that available resources are being used in a timely and cost-effective manner to obtain optimum value for both the client and the reimbursement source. Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel to optimize the outcome for all concerned.
Case managers can help people within the healthcare system understand:
- What they are going through.
- What they need to do.
- Why they need to do it.
- Which resources may be available.
- How to connect to information on insurance benefits.
- How to manage day-to-day How to find the care you need when you need it.
At Associated Insurance Brokers, we believe that case management service is a very essential piece in providing the optimal level of health insurance service to our clients and their insured members. Therefore, we have collaborated with professional case managers who have supported couple of our client’s insured members suffering from complex physical, psychological & health conditions, to receive the ultimate appropriate healthcare services while ensuring that the insurance companies did not incur any unnecessary costs. The efficient case management approach that is used, will benefit all parties involved (the patient, the patient’s employer and the insurance company).
The Patient will receive the upmost health insurance service, emotional support & guidance throughout the treatment and after the treatment as well.
The Insurance Company will not incur any unnecessary costs.
The Patient’s Employer is aware that his employee is in safe professional hands and his case is being monitored on daily basis. Moreover, by reducing the unnecessary costs that the insurer will incur throughout the process, Associated Insurance Brokers’ team are controlling the annual loss ratio of their group health insurance scheme.
