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What Is Utilization And Case Management In Healthcare?

What Is Utilization And Case Management In Healthcare
What Is Utilization Management in Healthcare? – Utilization management (UM) is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis.

  • Inpatient admissions
  • Inpatient days
  • Skilled Nursing Facility (SNF) admissions
  • SNF inpatient days
  • Home health visits
  • ER visits
  • Outpatient visits

Other metrics (usually tracked by number of patients per month or per year) can include primary care physicians visits, specialty referrals, high-cost imaging (MRI, PET, etc.), and cost per visit.

What does utilization mean in health?

Health care services utilization refers to how much health care people use, the types of health care they use, and the timing of that care.

What does utilization mean in management?

From Wikipedia, the free encyclopedia Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.

Is case management the same as UM?

While drafting a presentation to the senior leadership committee, the presenter wants to know: should both functions be combined? First, an interesting bit out of Becker’s today: the largest percentage of nurses leaving hospital work (or the profession) are those younger than 35.

  • A much smaller percentage of the 49-plus crowd left many can afford to retire with union pensions or good 401K returns —whereas those between 35 and 49 pretty much stuck around.
  • Nursing schools must not be teaching students that they are bullet-proof anymore.
  • Being somewhere north of 35 I figure I’m good, nothing’s killed me yet.

Which brings me to my thoughts for today. A fellow member of the American Case Management Association (ACMA) asked on our message board a question about formation of a CM/UM department. She is working on a presentation to the senior leadership about team structure, skills, profiles, and duties for the CM department.

  • She is looking for suggestions on how to define the UM function.
  • Excellent question.
  • Case management and UM can be structured in different ways: combining UM and CM into a single role or dividing them into separate roles in the same department.
  • Some hospitals and systems have formed completely separate departments, often in a centralized, system-wide remote location.

Personally, I think the last two are bad ideas, or at least more challenging to make them as effective as all falling under one department and on-site. Feel free to disagree. I still, have things to learn. First, it’s not a job where old nurses with bad backs go to die — or physicians wanting to get off the train for a slower paced occupation as a PA.

Those who have demonstrated clinical competency. Why? Because the reviewer must understand the treatment plan in order to make any judgments about it or interventions in supportGood communicators. UM is all about communication, with clinicians and payersFearless. Good UM professionals have to be ready to communicate with providers and payers concisely and with convictionFriendly, because people will do for friends what they won’t do for anyone elseHave the ability to think beyond InterQual and MCG. Both are applicable only 70 to 75 percent of the time. The rest of the time the UM professional must think critically and independently

How the position and unit are structured is dependent on the overall organization or system. My preference is and may always be based on personal interaction. I honestly don’t know how anyone gets the job done 100 percent remotely. I suspect there are both benefits (centralization) and drawbacks (lacking prior mentioned relational value).

  • One day I may oversee one and I’ll get back to you.
  • UM is more than just evaluating a medical record, it’s having impact with the clinicians to teach them how to do the mundane, such as getting status orders right, to the more complex such as clinical documentation improvement.
  • After all, who is better situated than someone who critiques medical records all day to talk with providers about CDI? UM and CM department leadership are a part of the organization’s UM Committee: people who can identify trends and effectively present them to medical staff for consideration.

An effective UM Committee is not only an information processing body, but an interpreting body with a mission to educate. And sometimes that is actually achieved. To be clear, per the Medicare Conditions of Participation, the UM Committee has a wide-ranging scope beyond what the UM department brings to the table.

Is case management effective?

This systematic review found that studies of case management interventions have adequate quality and, in many cases, show cost-effective or even cost-saving results. ABSTRACT Objectives: In this time of aging and increasingly multimorbid populations, effective and efficient case management approaches play a crucial role in supporting patients who are navigating complex health care systems.

Until now, no rigorous systematic review has synthesized studies about the cost-effectiveness of case management. Study Design: A systematic review was performed. Methods: The bibliographic databases PubMed and CINAHL Plus were systematically searched using key blocks and synonyms of the terms case management, effectiveness, and costs,

The methodological quality of the studies was assessed using the Consensus Health Economic Criteria list. Results: A total of 29 studies were included. In 3 studies, the intervention was less effective and more costly than the control group and can therefore be considered not cost-effective.

Two studies found that the intervention was less effective and less costly. A more effective and less costly intervention, and therefore a strong recommendation for case management, was found in 6 studies. In 17 studies, the intervention was more effective while being more costly. Nearly half of the studies met most of the quality criteria, with 16 or more points out of 19.

Conclusions: Existing studies often have adequate quality and, in many cases, show cost-effective or even cost-saving results. Case management appears to be a promising method to support patients facing complex care situations. However, variation among case management approaches is very high, and the topic needs further study to determine the most cost-effective way of providing such care coordination.

Case management approaches play a crucial role in supporting patients who are navigating complex health care systems.Case management intervention studies often have adequate quality and, in many cases, show cost-effective or even cost-saving results.Variation among case management approaches is very high, and the topic needs further study to determine the most cost-effective way of providing such care coordination.

_ Health systems around the world are getting more complex. This increasing complexity may affect patients’ ability to access the right health services at the right time. This struggle to navigate the system has individual implications for the care seeker’s well-being and economic implications when it results in wasting the health system’s scarce resources and delaying the provision of the right treatment to the right patient or providing unnecessary care.

  1. Case management programs intend to guide individuals with complex medical needs through the health system to improve health service effectiveness and the efficiency of service provision.
  2. The concept of case management is not new; it has been practiced in the United States for more than a century, primarily in the disciplines of nursing and social services.1 Case management programs are generally designed to tackle the challenges of episodic care, which are often fraught with inadequate transitions between care services and health care settings.

The programs aim to coordinate fragmented services by providing guidance to individuals, attempting to improve health service effectiveness and reduce cost. Ideally, a case management program facilitates communication and the coordination of care, and its collaborative practice includes patients, caregivers, nurses, social workers, physicians, payers, support staff, other practitioners, and the community.2 The oldest and largest case management membership organization in the world, the Case Management Society of America, which facilitates the growth and development of case management, defines case management as “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 patient safety, quality of care, and cost-effective outcomes.” 3 As defined by the UK-based Medical Research Council as well, case management is quite complex.4 The complexity of case management interventions arises from, among other factors, the number of groups or organizational levels targeted by the intervention, the number and variability of outcomes, the number and difficulty of behaviors required by those delivering or receiving the intervention, and the degree of flexibility or tailoring of the intervention.

  • Furthermore, there is complexity in the intervention components, among them case finding and assessment, case planning, navigation and coordination, monitoring, and reviewing of the case plan.
  • These components aim to improve continuity of care and to enhance patients’ self-management skills and hence are intended to increase efficiency within the health care system.

Especially in regard to the aging multimorbid population, case management may play an important role in the support of patients facing complex care situations. With better coordination, it is posited, the health system’s ability to provide high-quality care and maintain resource requirements can improve.

One recent analysis of case management’s effectiveness is the RubiN project (funded by the Federal Joint Committee’s German Innovations Fund), which is evaluating the implementation of case management for geriatric patients. The goal of RubiN is to develop a form of care throughout Germany that enables older people to remain in their homes for as long as possible.

It is hoped that by case managers informing and guiding patients and their (caretaking) relatives, the quality of treatment will rise—by closing gaps in care—and support will be provided to physicians—by conserving scarce personnel resources. Here, we set out to provide an overview of the evidence regarding cost-effectiveness of case management; until now, no systematic review has been conducted on this topic.

Yet systematic reviews that have been done on case management’s overall effectiveness are promising: They have found that case management can effectively reduce hospital use and improve satisfaction with care when chronic illnesses are present.5-7 Furthermore, a systematic review of reviews has found evidence that case management interventions reduce health care utilization in patients with chronic illnesses.8 However, the question of whether case management is cost- effective has so far not been adequately addressed.

Further, it is unclear whether cost-effective case management interventions have certain characteristics in common. The aim of this systematic review is therefore to investigate the cost-effectiveness of case management. METHODS Objectives and Study Design The objective of this systematic review was to synthesize the evidence for cost-effectiveness of case management.We conducted a systematic review of the literature following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.9 Also, this review reported according to the PICOS (Population, Intervention, Comparison, Outcomes, Setting) Framework.10 A protocol was developed before searching electronic databases.

  1. Eligibility Criteria Inclusion and exclusion criteria are outlined in Table 1,
  2. Briefly, the review included cost-effectiveness studies that compare case management interventions with usual care.
  3. Model-based studies were excluded.
  4. No limits were applied to language and publication date.
  5. Electronic Bibliographic Database Searches The bibliographic databases PubMed and CINAHL Plus were systematically searched using key blocks of the terms case management, effectiveness, and costs and their synonyms.

A complete search strategy list is provided in the eAppendix ( available at ). Study Selection Two authors (A.K.K. and J.J.) independently screened titles and abstracts from unduplicated references. The full text was reviewed when a decision was not possible from reading the abstract.

  1. Any discrepancies were resolved by discussion.
  2. Data Collection and Synthesis Data were collected using an extraction form developed to retrieve relevant information.
  3. This included study characteristics (nation, setting, patient group and sample size, comparison group, study design, type of economic evaluation, study duration), case management characteristics (case management model, intensity of intervention, team or single case manager, training received, supervision, 24-hour availability of case manager, caseload per manager/team), and outcome characteristics (outcome measures, costs included, cost perspective, time horizon, cost analysis method, findings, sensitivity analysis/uncertainty assessment).
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The studies were summarized and synthesized by the first author independently. The extraction table is provided in the eAppendix. Quality Assessment The methodological quality of the cost-effectiveness analyses was assessed by the Consensus Health Economic Criteria (CHEC) list.11 If a study qualified in a criterion, it scored 1; otherwise, it scored 0.

  1. Thus, this tool’s range was 0 to 19.
  2. In cases in which criteria were not applicable (eg, the question about the appropriate discount rate in a year-long study), the overall achievable score was reduced.
  3. Quality appraisal was verified by a second reviewer.
  4. RESULTS Study Selection A total of 2388 unduplicated studies were retrieved from the database searches.

After reading titles and abstracts, 61 full texts were analyzed, and inclusion and exclusion criteria were applied. From these, 32 studies were excluded. The remaining 29 studies were included in the qualitative analysis of the review. A flow diagram of this process, according to PRISMA guidelines, is presented in Figure 1,9 Quality Assessment The results of the CHEC list show that nearly half of the studies (n = 13) met most of the quality criteria (≥ 16 of 19).12-24 The main limitations were the narrow perspective chosen, as only about a quarter (n = 7) of all studies chose a broad societal perspective, 12,16,17,20,23,25,26 and the chosen short time horizon, which was only 1 year in about half the studies (n = 14).13,16,19,26-36 Study Characteristics Studies were from the United States (n = 12) 13-16,18,28,29,34,35,37-39 more than from any other nation, followed by studies from Germany (n = 8), 12,20,21,24,26,30,31,33 the Netherlands (n = 4), 17,19,22,23 the United Kingdom (n = 2), 32,40 Sweden (n = 1), 25 Denmark (n = 1), 36 and Canada (n = 1).27 Except for one, 33 all studies were trial-based economic evaluations, assessing the cost-effectiveness of case management compared with usual care.

Twenty-two of the economic evaluations were based on randomized controlled trials (RCTs) 12-16,18,20-30,32,34,36,39,40 ; the rest used non-RCT designs, such as nonrandomized controlled observational studies. Twenty of the studies adopted a health care system perspective in the analysis.13-15,19,21,24,27-40 A societal perspective was adopted by 7 studies.12,16,17,20,23,25,26 One study took the employers’ perspective.18 One study adopted a health care perspective, a social care perspective, and a societal perspective.22 Patient Groups The patient group represented more than any other (see Table 2 12-40 ) were those with psychiatric disorders (n = 9), such as depressive disorders, anxiety, and/or posttraumatic stress disorder 12,15,16,18,22,30,31,35,39 ; they were followed by older patients (n = 4), 19,25,29,38 patients with dementia (n = 3), 17,24,33 and patients with diabetes (n = 2).13,37 Further, several studies included patients belonging to more than 1 patient group, such as patients with diabetes and depression, 14 older patients with depression, 32,40 and older patients with myocardial infarction.20,26 The rest of the studies included patients with HIV, 23 chronic obstructive pulmonary disease, 27,36 elevated blood pressure, 28 hypercholesterolemia, 34 and a long-term indication for oral anticoagulation therapy.21 Case Management Model In most studies, the case management interventions were described in enough detail to identify the program components.

These components are case finding and assessment, case planning, navigation and coordination, monitoring, and reviewing of the case plan (Table 2 12-40 ). The component of monitoring could be found in most descriptions of the case management intervention: Symptom monitoring and regular visits or telephone calls were described in 24 studies.

Furthermore, the case management models often included navigation and coordination (n = 19) and health education (n = 17) components, such as informing the patient about the disease, counseling on general health behavior, emphasizing lifestyle changes, and promoting treatment adherence, self-care, and autonomy.

A combination of the components of monitoring and health education was often described, 13,15,21,23,27 as was the combination of monitoring and navigation/coordination.14,32,37,39,40 A case management model with all components (assessment, case planning, navigation and coordination, monitoring, and health education) was described in 5 studies.22,25,28,29,36 Case Managers Case managers were nurses, health care assistants, social workers, physiotherapists, clinical therapists, pharmacists, and mental health workers.

About half the studies (n = 14) stated that the case managers received training beforehand. The scope of the training received was heterogenous, with a duration of several hours, 2 days, or even 2 weeks. Case managers worked alone, although they frequently collaborated closely with the patient’s physician.

Caseloads ranged between 10 and 76 patients, although 1 study analyzing a telecommunication-supported case management model stated a caseload of up to 120 less-active cases.35 Outcomes and Costs Highly heterogeneous among the studies were the outcomes.

They included patient utility measures (eg, quality of life with EuroQol 5-dimension instrument, Short Form-36 questionnaire, World Health Organization Quality of Life), patient health effect measures (eg, mortality, symptoms, functioning in activities of daily living), other patient-relevant measures or system measures (eg, outpatient contacts, time in patients’ home environment, absenteeism), and situational program measures (eg, quality of parenting, abstinence).

Depending on the perspective chosen, intervention costs, direct medical costs (eg, inpatient and outpatient costs, emergency department costs, medication costs), direct nonmedical costs (costs for social support services ), and indirect costs (eg, informal care costs and productivity losses) were included in the analyses of the studies.

  • A table of perspectives chosen and costs included is provided in the eAppendix.
  • Economic Analyses Findings regarding the economic analyses, the classification within the cost-effectiveness plane, and the results of the quality assessment using the CHEC list are listed in the results grid ( Table 3 12-40 ).

All except 2 studies 20,25 included an incremental analysis of costs and outcomes; most calculated an incremental cost-effectiveness ratio (n = 24) and conducted a sensitivity analysis (n = 24). In Figure 2, results are visualized in a cost-effectiveness plane, which is used to visually represent the differences in costs and health outcomes (effects) between treatment alternatives in 2 dimensions by plotting the costs against effects on a graph.

Effects and costs are plotted on the x-axis and y-axis, respectively. The cost-effectiveness plane includes 4 quadrants: northwest (NW), southwest (SW), northeast (NE), and southeast (SE). In 3 studies, the intervention was less effective and more costly than the control group (NW quadrant) and can therefore be considered not cost-effective.19,30,35 The intervention is dominated by usual care.

Two studies found that the intervention was less effective and less costly (SW quadrant). One of these studies found that both costs (–€17.61) and effects (–0.0163 quality-adjusted life-years ) were lower in the intervention group; therefore, the incremental cost-effectiveness ratio (€1080/QALY) represents the savings per additional QALY lost.26 A study from the Netherlands, 17 which analyzed the cost-effectiveness of case management for patients with diagnosed dementia and their informal caregivers, found that the intervention saves costs and there is an approximately 45% chance that the intervention also has positive effects.

A more effective and less costly intervention (SE quadrant), and therefore evidence for cost-effectiveness, was provided in 6 studies.12,20,24,27-29 The majority of studies (n = 18) found that the intervention was more effective while being more costly (NE quadrant). Of these, 7 studies reported incremental cost-effectiveness ratios below a willingness-to-pay threshold of US$50,000 for the gain of 1 QALY.14,16,21,23,32,36,40 Only 1 study used QALYs and found that case management is not cost effective at US$50,000.13 The remaining studies either used different outcome measures or did not provide a recommendation.

Case management interventions across all studies varied considerably. In cost-effective case management interventions, no patterns of common characteristics, such as case management model, type of case manager, or patient group, could be identified. No correlation of cost-effectiveness with a certain kind of health care system, study design, or time horizon could be observed either.

  • Therefore, it remains unclear what makes some case management interventions cost-effective.
  • DISCUSSION To our knowledge, this is the first systematic review that systematically synthesized studies to identify the cost-effectiveness of case management interventions.
  • We identified 29 studies, which were published between 2000 and 2019.

All studies compared case management to usual care without case management. The results of the quality assessment of economic evaluations show that the quality of the included studies is good, although most studies chose a payer’s perspective and therefore did not include indirect costs such as productivity losses.

In addition, in about half of all studies, the chosen time horizon was only 1 year. This is a short observation period, not appropriate to capture all relevant outcomes, because case management effects might be visible only after longer periods of time. In addition, considering that at the beginning of an intervention, costs of case management can be considerably higher because of up-front training costs, a relatively short study period of only 1 year might distort results.

Results of the KORINNA studies illustrate this: After 1 year the case management for elderly patients with myocardial infarction was deemed less effective and less costly than usual care, 26 but a follow-up after 3 years 20 showed higher QALYs, significantly better quality of life, and lower costs (although not significantly lower).

  1. Hence, longer study durations are strongly recommended.
  2. To provide successful case management, case managers require specialized training.
  3. However, only half of the studies stated that the case managers received training.
  4. A detailed description of the scope and content of training was scarce.
  5. The same applies for data on caseloads and descriptions of the intensity of case management—in other words, the patient contacts.

We therefore recommend that studies provide detailed intervention protocols. Limitations The studies included conducted their interventions in 7 nations in which transferability of the data and conclusions to the German context was possible. Evidence from low- and middle-income countries was not included in this systematic review, and therefore its results may not be broadly applicable.

CONCLUSIONS This systematic review found that because of a large variation in case management programs, the evidence for cost-effectiveness is not yet fully conclusive for case management in general. More definitive studies with a defined protocol of case management are needed to determine cost-effectiveness.

However, the existing studies often have adequate quality and, in most cases, produce recommendable conclusions. The confluence of highly developed health systems, fragmented health care services, and aging populations with multimorbidity is a situation that calls out for individualized coordination and support.

  1. Case management appears to be a promising method to support patients facing complex care situations.
  2. We therefore advise policy makers to establish case management programs as core components of effective, patient-oriented health care systems, and to support rigorous evaluation of each program.  Author Affiliations: inav – Institute for Applied Health Services Research (AKK, JJ, FF, MA), Berlin, Germany.

Source of Funding: This study was conducted in the context of the research project RubiN, funded by the Federal Joint Committee’s German Innovations Fund. Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (AKK, JJ, FF, MA); acquisition of data (AKK, JJ); analysis and interpretation of data (AKK, MA); drafting of the manuscript (AKK); critical revision of the manuscript for important intellectual content (JJ, FF, MA); administrative, technical, or logistic support (AKK, FF); and supervision (MA).

Address Correspondence to: Ann-Kathrin Klaehn, MSc, inav – Institute for Applied Health Services Research, Schiffbauerdamm 12, 10117 Berlin, Germany. Email: [email protected]. REFERENCES 1. Kersbergen AL. Case management: a rich history of coordinating care to control costs.

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Cost-effectiveness of case management in substance abuse treatment. Res Soc Work Pract,2016;16(1):38-47. doi:10.1177/1049731505276408 36. Sørensen SS, Pedersen KM, Weinreich UM, Ehlers L. Economic evaluation of community-based case management of patients suffering from chronic obstructive pulmonary disease.

Appl Health Econ Health Policy,2017;15(3):413-424. doi:10.1007/s40258-016-0298-2 37. Hay JW, Lee PJ, Jin H, et al. Cost-effectiveness of a technology-facilitated depression care management adoption model in safety-net primary care patients with type 2 diabetes.

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Arch Gen Psychiatry,2009;66(10):1081-1089. doi:10.1001/archgenpsychiatry.2009.123 40. Bosanquet K, Adamson J, Atherton K, et al. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness.

What is the process of utilization?

Calculate process utilization – ” – Calculating the utilization of a single resource provides useful insights into your process. The next step of that analysis is to identify the utilization level for the process as a whole. In this movie, I will show you how to do that.

My sample file is the Process Utilization Workbook, and you can find it in the Chapter Two folder of the Exercise Files Collection. The utilization of a process is the ratio of its flow rate, to the overall process capacity. I’ve done a fair number of preliminary calculations that I’ve covered elsewhere in this course.

I have a six resource process, and in row five you’ll see that we have the processing time for each of the resources. Then I calculate my capacity per minute. And I can do that directly, because my processing time for each resource is expressed in minutes.

What does case management include?

Case Management – Case management is a multi-step process to ensure timely access to and coordination of medical and psychosocial services for a person living with HIV/AIDS and, in some models, his or her family/close support system. Case management includes the following processes: intake, assessment of needs, service planning, service plan implementation, service coordination, monitoring and follow-up, reassessment, case conferencing, crisis intervention, and case closure.

Case management activities are diverse. In addition to assisting clients to access and maintain specific services, case management activities may include negotiation and advocacy for services, consultation with providers, navigation through the service system, psycho-social support, supportive counseling, and general client education.

The goal of case management is to promote and support independence and self-sufficiency. As such, the case management process requires the consent and active participation of the client in decision-making, and supports a client’s right to privacy, confidentiality, self-determination, dignity and respect, nondiscrimination, compassionate non-judgmental care, a culturally competent provider, and quality case management services.

For families caring for HIV infected or affected children, an additional goal of case management is to maintain and enhance the effective functioning of the family, and to support parents in their care-giving role. Case management services to children must be matched to their age and developmental level, enhance functioning and growth, and include children’s participation in decision-making, as appropriate to their age and abilities.

The intended outcomes of HIV/AIDS case management for persons living with HIV/AIDS include:

Early access to and maintenance of comprehensive health care and social services. Improved integration of services provided across a variety of settings. Enhanced continuity of care. Prevention of disease transmission and delay of HIV progression. Increased knowledge of HIV disease. Greater participation in and optimal use of the health and social service system. Reinforcement of positive health behaviors. Personal empowerment. An improved quality of life.

What is in case management?

Definition/Introduction – Case management is defined as a health care process in which a professional helps a patient or client develop a plan that coordinates and integrates the support services that the patient/client needs to optimize the healthcare and psychosocial possible goals and outcomes.

The case management process helps the patient and their family navigate through a complicated set of services and supports available within a benefit plan, an organization or institution, and their community. Concerning cost-effective outcome analysis, Hudon et al. found that approximately 10% of patients account for approximately 70% of all healthcare expenditures.

Statistics show that 5% of emergency department patients account for 30 to 50% of emergency department visits and these high utilizing patients may unsuccessfully attempt to meet their healthcare and related needs on their own which often is ineffective, characterized by overutilization of expensive, or underutilization and uncoordinated effective health care and social services.

  • Case management is often a part of other healthcare activities embodied in terms such as care management, care coordination, and disease management.
  • All these terms have overlapping definitions and identities.
  • Case management is a fundamental element of these other activities.
  • Care management, frequently used in the payer context, is somewhat of an umbrella term and describes a program composed of a broad set of activities and tasks that include the healthcare-related aspects of case management but also extends to a wide array of services, supports, benefits, and entitlements spanning many domains to which the patient/client may have access, including healthy lifestyle programs, recreational activities, and social enrichment programs within a benefit plan.

Care coordination also encompasses the activities and tasks included in case management but is seen in a broader programmatic context and frequently is discussed in the population health context as a means for an organization or institution pursuing population health strategies to manage the many needs of a population of patients, often by determining specific sub-groups who should receive case management services.

  • In contrast to care management and care coordination, disease management is a narrower form of case management.
  • It typically is case management directed at particular patient groups who all share a common diagnosis or condition.
  • For example, patients with arthritis or patients after joint replacement surgery may be offered a discrete disease management program for a specific period.

Those professionals who conduct case management are described as service brokers, service coordinators, or system navigators. Since health care is often likened to a journey, other metaphors like travel companion, travel agent, and travel guide are used that attempt to capture not only the centrality of case management to the health care journey but also the need for navigational assistance in helping to shape the itinerary of the health care journey for the patient/client.

See also:  What Is Hcp In Healthcare?

The components of case management are many. Hudon et al. summarize several descriptions of case management including those from the Case Management Society of America and the National Case Management Network of Canada and describe six core elements which include patient identification and eligibility determination, assessment, care planning along with goal setting, plan implementation, plan monitoring, and transition and discharge.

Ahmed and Kanter, also summarize similar case management core element lists. However, case management descriptions may go beyond these six core elements and include additional activities and tasks that comprise case management. In a literature review, Lukersmith et al.

Identified 79 articles that identified 22 definitions of case management, described five models, and delineated 17 key components to case management comprising 69 activities and tasks that include and build upon the six core elements. This variability in both the definition and description of case management may lead to an amorphous sense of case management in a given healthcare initiative.

It may also contribute to potential role confusion and ambiguity among those who conduct case management activities and tasks. The 17 key components identified in the literature review include: case finding, establishing rapport, assessment, planning, navigation, provision of care, implementation, coordination, monitoring, evaluation, feedback, providing education and information, advocacy, supportive counseling, administration, discharge, and community service development.

Since case management is so encompassing as a concept and a set of activities and tasks in health care, there are many perspectives from which to understand and view case management. Case management may be used by health insurers/payers, hospitals, health systems, physician practices, and community health organizations.

Also, case management may be directed at broad populations of patients in primary care with various chronic conditions or a more narrowly defined population of patients affected by a specific clinical circumstance or disease, such as patients with brain injury.

What is case management also known as?

What is Case Management? A Scoping and Mapping Review Reading: What is Case Management? A Scoping and Mapping Review

Sue LukersmithMichael MillingtonLuis Salvador-Carulla

The description of case management in research and clinical practice is highly variable which impedes quality analysis, policy and planning. Case management makes a unique contribution towards the integration of health care, social services and other sector services and supports for people with complex health conditions.

There are multiple components and variations of case management depending on the context and client population. This paper aims to scope and map case management in the literature to identify how case management is described in the literature for key complex health conditions (e.g., brain injury, diabetes, mental health, spinal cord injury).

Following literature searches in multiple databases, grey literature and exclusion by health condition, community-based and adequate description, there were 661 potential papers for data extraction. Data from 79 papers (1988–2013) were analysed to the point of saturation (no new information) and mapped to the model, components and activities.

The results included 22 definitions, five models, with 69 activities or tasks of case managers mapped to 17 key components (interventions). The results confirm the significant terminological variance in case management which produces role confusion, ambiguity and hinders comparability across different health conditions and contexts.

There is an urgent need for an internationally agreed taxonomy for the coordination, navigation and management of care.

Volume: 16Page/Article: 2

Submitted on 4 May 2016 Accepted on 26 Sep 2016 Published on 19 Oct 2016

: What is Case Management? A Scoping and Mapping Review

What are the 5 principles of case management?

Case Management Philosophy and Guiding Principles – Case management is a specialty practice within the health and human services profession. Everyone directly or indirectly involved in healthcare benefits when healthcare professionals and especially case managers appropriately manage, efficiently provide, and effectively execute a client’s care.

  • Case management is not a profession unto itself. Rather, it is a cross-disciplinary and interdependent specialty practice.
  • Case management is a means for improving clients’ health and promoting wellness and autonomy through advocacy, communication, education, identification of service resources, and facilitation of service.
  • Case management is guided by the ethical principles of autonomy, beneficence, nonmaleficence, veracity, equity, and justice.
  • Case managers come from different backgrounds within health and human services professions, including nursing, medicine, social work, rehabilitation counseling, workers’ compensation, and mental and behavioral health.
  • The primary function of case managers is to advocate for clients/support systems. Case managers understand the importance of achieving quality outcomes for their clients and commit to the appropriate use of resources and empowerment of clients in a manner that is supportive and objective.
  • Case managers’ first duty is to their clients – coordinating care that is safe, timely, effective, efficient, equitable, and client-centered.
  • Case management services are offered according to the clients’ benefits as stipulated in their health insurance plans, where applicable.
  • The Case Management Process is centered on clients/support systems. It is wholistic in its handling of clients’ situations (e.g., addressing medical, physical, functional, emotional, financial, psychosocial, behavioral, spiritual, and other needs), as well as those of their support systems.
  • The Case Management Process is adaptive to case managers’ practice settings and the settings where clients receive health and human services.
  • Case managers approach the provision of case-managed health and human services in a collaborative manner. Professionals from within or across healthcare organizations (e.g., provider, employer, payor, and community agencies) and settings collaborate closely for the benefit of clients/support systems.
  • The goals of case management are first and foremost focused on improving the client’s clinical, functional, emotional, and psychosocial status.
  • The healthcare organizations for which case managers work may also benefit from case management services. They may realize lowered health claim costs (if payor-based), shorter lengths of stay (if acute care-based), or early return to work and reduced absenteeism (if employer-based).
  • All stakeholders benefit when clients reach their optimum level of wellness, self-care management, and functional capability. These stakeholders include the clients themselves, their support systems, and the healthcare delivery systems, including the providers of care, the employers, and the various payor sources.
  • Case management helps clients achieve wellness and autonomy through advocacy, comprehensive assessment, planning, communication, health education and engagement, resource management, service facilitation, and use of evidence-based guidelines or standards.
  • Based on the cultural beliefs, values, and needs of clients/support systems, and in collaboration with all service providers (both healthcare professionals and paraprofessionals), case managers link clients/support systems with appropriate providers of care and resources throughout the continuum of health and human services and across various care settings. They do so while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all stakeholders.
  • Case management services are optimized when offered in a climate that allows direct, open, and honest communication and collaboration among the case manager, the client/support system, the payor, the primary care provider (PCP), the specialty care provider (SCP), and all other service delivery professionals and paraprofessionals.
  • Case managers enhance the case management services and their associated outcomes by maintaining clients’ privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards and guidelines, as appropriate to the practice setting.
  • Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to their clients/support systems.
  • Case managers must demonstrate a sense of commitment and obligation to maintain current knowledge, skills, and competencies. They also must disseminate their practice innovations and findings from research activities to the case management community for the benefit of advancing the field of case management.

What is the difference between utilization and utilization?

Language Utilization and utilisation are both English terms. Usage Utilization is predominantly used in 🇺🇸 American (US) English ( en-US ) while utilisation is predominantly used in 🇬🇧 British English (used in UK/AU/NZ) ( en-GB ). In terms of actual appearance and usage, here’s a breakdown by country, with usage level out of 100 (if available) 👇:

Term US UK India Philippines Canada Australia Liberia Ireland New Zealand Jamaica Trinidad & Tobago Guyana
utilization 96 40 66 98 18 43 0 48 46 100 100 100
utilisation 4 60 34 2 82 57 0 52 54 0 0 0

ul> In the United States, there is a preference for ” utilization ” over “utilisation” (96 to 4). In the United Kingdom, there is a 60 to 40 preference for ” utilisation ” over “utilization”. In India, there is a preference for ” utilization ” over “utilisation” (66 to 34). In the Philippines, there is a preference for ” utilization ” over “utilisation” (98 to 2). In Canada, there is a 82 to 18 preference for ” utilisation ” over “utilization”. In Australia, there is a 57 to 43 preference for ” utilisation ” over “utilization”. In Liberia, there is not enough data to determine a preference between “utilization” and “utilisation”. In Ireland, there is a 52 to 48 preference for ” utilisation ” over “utilization”. In New Zealand, there is a 54 to 46 preference for ” utilisation ” over “utilization”. In Jamaica, there is a preference for ” utilization ” over “utilisation” (100 to 0). In Trinidad & Tobago, there is a preference for ” utilization ” over “utilisation” (100 to 0). In Guyana, there is a preference for ” utilization ” over “utilisation” (100 to 0).

Examples Below, we provide some examples of when to use utilization or utilisation with sample sentences. Trends 📈 See Trends Looking for a tool that handles this for you wherever you write? Get Sapling

What are the benefits of utilization?

What are the benefits of resource utilization? – Resource utilization, ultimately, helps you make the most of your available resources:

Proper utilization of resources is important for maintaining productivity, because it prevents staff from underperforming or being overburdened by workloads and burning out Projects can be managed with better visibility, reducing the risk of oversights Maximum utilization of resources gives you a better ROI It ensures that specific resources aren’t being over- or under-utilized It allows PMs to be agile and reschedule resources as quickly as possible to avoid problems surfacing or becoming worse

What are utilization goals?

Utilization Goal means the percentage goals set for Certified Firms and workforce utilization on contracts and projects subject to the Policy.

What is the definition of terms of utilization?

/ˌjuː.tɪ.laɪˈzeɪ.ʃən/ the act of using something in an effective way : Sensible utilization of the world’s resources is a priority. Resource utilization and cost-effective therapy are an integral part of modern medical practice. See.

How do you explain utilization factor?

Utilization factor Ratio of the time that a piece of equipment is in use to the total time that it could be in use

This article does not any, Please help by, Unsourced material may be challenged and, Find sources: – · · · · ( July 2021 ) ( )

Utilization factor (solid line) with blade-to-gas speed ratio The utilization factor or use factor is the ratio of the time that a piece of equipment is in use to the total time that it could be in use. It is often averaged over time in the definition such that the ratio becomes the amount of energy used divided by the maximum possible to be used. These definitions are equivalent.