Medical Case Management
The Case Management Society of America defines case management as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."
Case management focuses on delivering personalized services to patients to improve their care, and involves four steps:
- Screening to find appropriate patients
- Planning & delivery of care
- Evaluation of results for each patient & adjustment of the care plan
- Evaluation of overall program effectiveness & adjustment of the program
Case Managers are the bridge to matching needed resources to the client’s TRICARE or other health insurance coverage and can assist the client and their family to make informed decisions. Services include:
- Advocacy for client needs
- Development of an individualized case management plan
- Establishment of community or other federal support systems
- Liaison with Discharge planners/TSC Case Managers
- Analysis or healthcare plans to determine benefits
- Identification of cases with high risk/cost
- Coordination of services among providers
- Recommendations of additional therapies or discontinuation of services
- Evaluation of medical services for cost-containment potential
- Assistance with scheduling of interventions/services
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