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Private sector initiatives in case management.
Health Care Financing Review
|November 5, 1988
Summary
High-cost patient case management is common, but its processes, cost impact, and quality effects remain unclear. A survey of insurance programs revealed variations in case management processes that may affect effectiveness and costs.
Area of Science:
- Health Services Research
- Healthcare Management
Background:
- Case management for high-cost patients is widely available from private insurers and health management firms.
- There is limited understanding of the case management process, its variations, and its impact on patient costs and healthcare quality.
Purpose of the Study:
- To investigate the processes of case management for high-cost patients.
- To identify variations in case management among different vendors.
- To explore the impact of case management on short- and long-run patient costs and quality of care.
Main Methods:
- A survey of insurance-based case management programs was conducted.
- Data on program processes, costs, and quality were collected and analyzed.
Main Results:
- The survey revealed variations in the processes employed by different case management vendors.
- These process variations have the potential to influence program effectiveness and associated costs.
Conclusions:
- Understanding process variations in case management is crucial for optimizing program effectiveness.
- Further research is needed to fully elucidate the impact of case management on patient costs and quality.