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Related Experiment Videos

Case management: beyond the walls.

T Lutz1, S Lookinland

  • 1Community Health System, Fresno, CA, USA.

Cost & Quality Quarterly Journal : CQ
|December 8, 1996
PubMed
Summary
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Managed care is growing in California, increasing opportunities for case management to improve healthcare quality and reduce costs. Effective case management addresses clinical outcomes, member satisfaction, and cost containment for diverse patient needs.

Area of Science:

  • Healthcare Management
  • Health Services Research
  • Case Management

Background:

  • Managed care and capitation models are expanding in California's Central Valley.
  • This shift presents significant opportunities for case management within healthcare organizations.
  • Understanding the evolving healthcare landscape is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

  • To explore the role and impact of case management in a managed care environment.
  • To highlight how case management can influence quality and cost outcomes.
  • To examine the alignment of case management functions with the needs of managed care populations.

Main Methods:

  • The study focuses on the core components of case management: assessment skills for clinical outcomes, client-provider relationships for member satisfaction, and resource coordination for cost containment.

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  • It analyzes the congruence of these components with the demands of managed care.
  • The approach emphasizes the application of case management principles within the context of market share shifts.

    • Main Results:

    • Case management skills directly address key managed care objectives, including clinical outcomes, member satisfaction, and cost containment.
    • The role of the case manager is highly congruent with the needs of patients in managed care settings.
    • Case management strategies are vital for meeting the needs of high-risk patients.

    Conclusions:

    • Case management is essential for navigating the complexities of managed care, particularly in areas like California's Central Valley.
    • Effective case management positively impacts both the quality of care and healthcare costs.
    • Outcomes measurement mandates by payers will likely increase the use of case management, especially for high-risk populations outside traditional inpatient settings.