Case Study: Medicine and Health

Study of Case Management Programs as an Element of Quality Assurance (Student’s Name) (Course) (Instructor’s Name) (Date of Submission) Abstract This paper explores the case management programs as an element of Quality Assurance In Improving the medical practice and helping patients manage medical conditions more effectively. The paper also Inquires as to whether case management programs Improve the quality of care and reduce the costs, as well as the programs’ strengths and limitations.

Key words: Case Management, Gatekeepers. Introduction This term Case management Is sometimes substituted with ‘Care Coordination’. It Is a program that applies science, motivation, and enlightenment for the Improvement of medical efficiency and assists the patients manage conditions more effectually. The programs goal Is to better patient’s health status while reducing medical expenses Do case management programs Improve quality care or reduce medical costs?

Yes, the mall objective of case management programs Is to Improve quality health services offered to patients while effectively reducing their medical expenditure, both of which are delivered. Case management programs have been shown to Improve deiced coordination and delivery of medical services as a whole.

Individuals who have participated In the programs have found them Invaluable. According to a study from Health Dialog published In the New England Journal, trials have positively shown savings conveyed by a care management program.

The study monitored u patients over a pergola AT twelve Mont s n . Measurement AT Uninominal Neal outcomes and the total savings as a result of the care management program were conducted. After the period, individual average monthly expenses were shown to be $7. 96 less than they previously were.

Additionally, a 10. 1% reduction in annual hospital admissions costs were accounted for. With a $2. 00 per patient per month program charge, net savings to regular health plans came to an average of $6. 00 per patient per month. (Weinberg, 2010).

Positive results; therefore with refinement to the program results have the potential to grow even higher. Limitations and strengths of case management programs Strengths: In the past patients have found themselves in a confusing and unfamiliar world of procedures, services and treatments. Patients in the past might eave had to consult different departments to learn about various facets of their case. Case management has given patients a central point of contact. The case manager is that point; the patient can use him to acquire answers on diverse issues such as treatments, costs and appointments.

A case manager conducts internal communication in the organization in order to deliver definitive information to the The case managers also ensure that various members and departments patient. Within the organization deliver the services due to the patient promptly and properly. E. G. A case manager who is a skilled nurse will participate in meetings with the staff and administrators to develop a collaborated plan for care of the patient.

Case managers also provide an extra set of professional eyes monitoring every step of the patient’s treatment process.

Through this the patient is able to avoid unnecessary hectic processes he/she might have had to go through and in the process cuts down on the cost/expenses of they would have incurred without this professional guidance. Case managers catch errors, raise questions and express concerns that ascertain service is provided optimally with minimal cost incur. Limitations: There various drawbacks in the conducting of effective case management such as; the patient may feel that they are confined to seeing a doctor with whom they are unfamiliar with.

This may be mostly true where the care managers may change plans and the doctor a patient is familiar with does not participate in the new plan. This could result into extensive lack of coordination in the patient’s treatment process, hence hindering excellent health care and cost reductions in the process.

Another problem affecting case management is; in an attempt to save money, the primary doctor/ sectors often forgo necessary procedural facets of the treatment process that may often result into the patient’s condition spiraling out of control.

In most cases they prescribe over the counter medications to treat conditions that would have responded much better to prescription medication. Additionally, most people under case management programs complain of lack of choice even those living in large metropolitan areas with a vast range of excellent doctors. Patients under the programs also complain of the rigidity of the processes, and easily feel they are being arced through a very unfriendly system. This further provokes resistance on their part, resulting into limited efficiency in the programs.

Coxes, 2013). Will case management De a necessity In Torture? The question as to whether case management will become a necessity in the future is completely relative. In my opinion the necessity of case management, will remain totally dependent on such issues and circumstances as: The patient’s preferences; in light of the above mentioned drawbacks, individual patients may opt to forgo the program and proceed to tackle their condition/illness n their own without a case managers assistance.

Also, The patient’s condition: Some conditions are of a more serious standing than others. For example, a patient with a terminal condition that requires special attention and constant monitoring may opt to result to the case management where they will receive specialized attention, while a patient with a less serious condition such as a bacterial infection which does not require as much attention or constant monitoring, may result to forgo the program.

Additionally, The patients financial status: A patient of a less stable financial tutus, in an attempt to cut down on medical costs may result to the case management, while a patient of a more stable financial status who doesn’t find the cutting down of medical costs extremely impending may opt to forgo the program all together. Therefore the question of the case management program becoming a necessity in the future will be of a completely relative nature, depending on the individual wants and needs of each patient. American Hospital Association, 2000). Importance of gatekeepers to the case management program Gate manager play an important in case management by recognizing and intervening in high profile and costly patients. Through this they decrease the length of their stay, decrease the organizations financial loss while at the same time increasing the community collaboration.

In summary gatekeepers are the cost avoidance anchors of the case management programs.