The Role of the Case Manager

This week is Case Management week! Most people have heard the term case manager, but may be unfamiliar with the actual role of the position. Today’s healthcare environment demands constant attention to improvements in quality, safety, and the patient’s experience with care. The goal of any healthcare provider, including case managers and social workers, is to have patients want to return to them when necessary for their healthcare needs. A case manager or social worker plays an integral role in this by ensuring that the patients receive the highest level of care possible. They do this when they assess them, conduct a clinical review, prepare a discharge plan, or expedite a delay in delivery of care. In addition, as case managers, they also must ensure that the care to be provided at the next level following the inpatient stay is timely, appropriate, and meets a minimal standard of quality.

The Case Management Society of America’s (CMSA’s) definition reads as follow: “Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.”

Goals for case managers include:

  • Efficient use of resources and services

  • Meeting demands, interests, preferences and needs of patients

  • Enhancing patients’ and families’ experiences with care, including satisfaction

  • Provision of compassionate, ethical, and culturally competent patient/family-driven care

  • Ensuring patient safety through timely and appropriate care, reduced risk for injury, avoidance of medical errors, prevention of healthcare-acquired conditions, and safe discharge from acute care settings

  • Professional and satisfactory performance by providers

  • Lowering cost of care and health services by eliminating unnecessary use of resources, duplication, and fragmentation of services while ensuring continuity and care progression

  • Ensuring reimbursement in an era of value-based purchasing

Case managers work toward constantly providing safe, effective, efficient, timely, and patient-centered care. They play a crucial role in evaluating and monitoring a patient’s plan of care and outcomes such as discharge goals and avoidable readmissions. Case managers are the professionals most aware of the patient’s functional, physical, cognitive, emotional, and socioeconomic abilities and know best how these abilities may affect and determine a patient’s level of functioning after discharge/transition from an acute care setting or an episode of illness. Offering the best possible discharge plan is vitally important because of the potential for reducing readmissions and providing alternative care methods for less cost and most importantly patient, family, physician, and payer satisfaction.

If you know or see a case manager this week, be sure and thank them for their dedication to their field and for constantly working to better healthcare services.

(More information on the CMSA definition and philosophy of case management can be found at: http://bit.ly/1oJMfzL.) Source: https://www.ahcmedia.com/articles/140655-quality-of-care-and-the-role-of-the-case-manager

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