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Worker’s Compensation Programs Use Case Management to Coordinate the Physician and Other Provider Care with Vocational Training
Aug 16, 2006


Source: http://www.prweb.com/releases/2006/8/prweb424338.htm

Dublin (PRWEB) August 16, 2006 -- Research and Markets (http://www.researchandmarkets.com/reports/c40682) has announced the addition of Case or Care Management, 2nd edition 2006 to their offering

Case or care management is an outgrowth of the recognition that mechanisms to coordinate a relatively inefficient health care delivery system were needed to improve the overall quality of care as well as to reduce duplicative and unnecessary services. While utilization management (UM) is the evaluation of medical necessity, appropriateness, and efficiency of the use of health care resources, case management (CM) is a collaborative ongoing process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s needs through the coordination of available resources to support those specific care needs. UM is reactive, responding to requests for health care services while CM is proactive in the identification of needs and resources to meet those needs. UM has no or a very limited interaction with providers and patients while CM has ongoing communication. Both UM and CM address the appropriate and necessary utilization of health services at the most appropriate level of care, efficiency of care and quality of care.

The terms “case management” or “care management” has taken on myriad meanings and connotations over time. In general, CM involves a comprehensive system for complex care needs identification followed by the efficient management of an episode of illness that includes assessment, planning, implementation, coordination, monitoring, evaluation/re-evaluation, discharge functions and planning for continuity of care similar to other health care quality processes. CM should minimize fragmentation of care and maximize the coordination of needed services. CM must be designed to meet the needs of an individual patient.

Utilization reviewers are often called case managers, and in some cases, do perform some elements of case management for complex and high-risk cases where interdisciplinary management and resources are needed. Worker’s compensation programs use case management to coordinate the physician and other provider care with vocational training and other need services related to the worker’s disability. The goal of case management is to promote quality, cost-effective optimal outcomes and coordinate care across the continuum of needed supportive services, medical and in some cases, non-medical. Outcomes are driven by medical care only in part – financial, psychosocial, lifestyle and related issues often play a major role.

There are 128 pages of policies, procedures and strategies that ‘work’ to improve quality, efficiency of care while controlling unnecessary costs. Specific case management effectiveness data by disease entity.

Topics Covered:
- Forms.
- Patient Handouts.
- Position descriptions, competency requirements.
- References and resource materials.
- Web sites.

Care/case managers ensure that a multi-disciplinary team approach is used to assess, plan and deliver care. This team consists of the care coordinator, the member and family, informal caregivers, the physician(s), other agency case manager(s), and formal care givers.

Complex patient care service needs through a continuum of care or an episode of illness may include care in a hospital, subacute unit, nursing home, hospice, home, provision of necessary durable medical equipment (and related needs: for example a wheelchair-bound patient requires a ramp to allow egress in and out of the residence), infusion and nutritional services, personal care, homemaker services, respite care, adult day care, transportation, physician and other professional services, assisted living, mental health services, family and caregiver support services, vocational and employment counselling, adult protective, financial and legal services, amongst others. The funding to provide these services will usually come from a number of sources since health insurers do not cover many of these requirements.

The care coordinator screens the member for health risk factors, plans and coordinates services, evaluates care and cost efficiencies in conjunction with desired member outcomes, and advocates for the member in all venues of care. The emphasis of the program is to maintain or improve health and the functional ability of members, and the prevention of illness and injury. The care coordinator ensures access to care and medical management, supportive services and public health programs. Care coordinators oversee the efficient and effective use of resources, preventing redundant costs and services. Achievement of desired outcomes for care and member satisfaction is the principle goal of case management. CM programs have been developed by many medical care organizations and social service agencies using a diverse spectrum of providers as case managers that include Nurses, Advanced Practice Nurses, Social Workers, Psychologists and others.


For more information visit http://www.researchandmarkets.com/reports/c40682

Laura Wood
Senior Manager
Research and Markets
Fax: +353 1 4100 980

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